Search

Objective: Prior research has established that common therapeutic relationship factors are potent predictors of change in psychotherapy, but such factors are typically studied one at a time and their underlying structure when studied simultaneously is not clear. We assembled empirically validated relationship factors (e.g., therapist empathy; patient expectations; agreement about goals) into a single instrument and subjected it to factor analysis. Method: The instrument was applied to patients (N = 332) undergoing intensive psychotherapy of different types for depressive disorders, anxiety disorders, eating disorders, and childhood trauma in an inpatient specialized mental health setting. In order to examine the psychometric properties of the scale, we used half the sample (N=164) to conduct exploratory factor analysis (EFA) and parallel analysis before we tested the solution using exploratory structural equation modeling (ESEM) on the second half of the sample (N=168). Measurement invariance analysis was conducted to examine the stability of the factor structure. Results: The analysis yielded two factors, which were termed 1. "Confidence in the therapist" and 2. "Confidence in the treatment." Discussion: When assessed simultaneously, patients differentiate between their evaluation of the therapist and of the treatment. The results indicate that there is substantial overlap among previously established relationship factors.Trial registration: ClinicalTrials.gov identifier: NCT03503981.

This replication study examined the change over time and the relationship between depressive symptoms and dyadic adjustment during residential couple therapy and at one- and three-year follow-up. Mixed models were used in the analyses, and a disaggregation procedure was applied to examine the results on a between-person as well as on a within-person level. Overall, the results of the previous study were replicated. Significant improvement (

In 2014, Macnamara, Hambrick, and Oswald published a meta-analysis of studies questioning the strength of the association between deliberate practice and performance. In this brief report, the corr...

Clinical or methodological significance of this article: Meta-analysis is a powerful tool for resolving conflicting conjectures or findings while also providing a critical overview of a scientific area.

Some of the most important decisions that a researcher will make when conducting a meta-analysis are decisions about the search strategies and inclusion/exclusion criteria. Decisions regarding inclusion/exclusion criteria serve to define the scope of a meta-analysis and search strategy decisions can have a large impact on how well the results of a meta-analysis actually represent the existing body of literature. In this article, we provide descriptions and recommendations for performing searches and making inclusion/exclusion decisions. We also provide a review of 65 meta-analyses of psychotherapy versus pharmacotherapy in order to offer frequency data on the use of various search strategies and inclusion/exclusion decisions in the field.

Monitoring of ongoing psychotherapy is of crucial importance in improving the quality of mental health care, and feedback (FB) about patients' progress has been established as a viable means. The essential feature of FB models is that patient progress is measured continuously through therapy.This study investigated the effect of receiving a warning signal when a patient is not achieving expected improvement (not-on-track), monitored with the Norwegian version of the patient FB system OQ®-Analyst.Patients from six psychiatric clinics in Southern Norway (N = 259) were randomized to FB or no feedback (NFB).For the total sample, the FB effects appeared early (session three). Receiving a warning signal did not change the slope of patients' progress after the signal was given (FB versus NFB). FB seemed to be more effective with more severely distressed patients, although insignificant. Therapists indicated that the graphs imaging patient progress, and the accompanying discussion with the patient, were the most important aspects of FB.The use of OQ®-Analyst should be recommended in psychotherapeutic settings in Norway. Given the inconsistent results regarding the effect of warning signals, definitive conclusions about their effect may depend upon how and for whom it is used.

It has been claimed that the monitoring of ongoing psychotherapy is of crucial importance for improving the quality of mental health care. This study investigated the effect of using the Norwegian version of the patient feedback system OQ-Analyst using the Outcome Questionnaire-45.2. Patients from six psychiatric clinics in Southern Norway (N = 259) were randomized to feedback (FB) or no feedback (NFB). The main effect of feedback was statistical significant (p = .027), corroborating the hypothesis that feedback would improve the quality of services, although the size of the effect was small to moderate (d = 0.32). The benefits of feedback have to be considered against the costs of implementation.

Ubiquitous “sex tips” in popular media evidence an unquenchable public interest in learning how to experience “great sex,” and studies confirm that a great sexual relationship correlates to general relationship satisfaction, which in turn correlates to overall happiness. However, sexologists have paid scant attention to “optimal sexuality” and have focused instead on sexual dysfunction. While studies of optimal sexuality are few, we know enough to conclude that the paths to great sex depicted in popular media are largely dead ends. This article provides a framework for giving professional guidance to seekers of optimal sexuality.

In recent years, McNamara, and associates Hambrick and Oswald, conducted and published studies which purportedly showed deliberate practice exerts less powerful main effects than presented and popu...

Objectives: We investigated relationships between sense of self (SoS) and sense of others (SoO) and specific interpersonal problems in short-term dynamic and cognitive therapy. Method: 40 patients with Cluster C personality disorders from a RCT were included. The Achievement of Therapeutic Objective Scales (ATOS) was used to perform ratings of videotaped sessions. The Inventory of Interpersonal Problems Circumplex version was used as the outcome measure. Results: There were significant relationships between growth in SoS and SoO and reductions of hostile-dominant and hostile-submissive behaviors, as well as cold, social-avoidant and vindictive behaviors. Increase in SoO was also related to reductions in non-assertive and domineering behaviors. However, the results were only present in the STDP treatment group.

The psychometric properties of the process instrument Achievement of Therapeutic Objectives Scale (ATOS) were examined in this study. Generalizability Theory (GT) was used to evaluate variability attached to several possible sources of error. A random sample of 24 psychotherapy sessions was selected from a larger RCT trial including Cluster C patients and rated in different rating conditions (rating all scales versus rating a subgroup of the scales). Two G-study designs were used to compute variance components and generalizability coefficients. The results provided evidence that the ATOS is sensitive to differences among patients and to differences among subscales within patients (i.e., to different constructs within the ATOS). Rating condition contributed much to variability in scores when the ATOS scales were examined separately, but this variability was negligible when all scales were included in the same analysis. There was little variability due to raters, which indicates that adequately trained raters are able to apply the ATOS without contributing to measurement error.

The purpose of this study was to ascertain whether and how alliance and specific cognitive process may interact to influence outcome. Eighty social phobic patients were randomized to 10-week residential cognitive or interpersonal therapy, conducted mostly in groups. They completed process and outcome measures weekly. The ratings were analyzed with mixed models. It was found that initial patient-rated alliance predicted the course of social anxiety throughout therapy and that this effect was indirect through the cognitive process. However, this indirect effect did not interact with treatment. There was a trend toward an indirect effect of weekly variations in alliance rated by the individual therapist through weekly variations in subsequent cognitive process on weekly variations in subsequent social anxiety. Thus, the results support a facilitative rather than an active ingredient perspective on the role of alliance.

Allegiance effects have been discussed, debated, and tested over the past several decades. The evidence clearly shows that allegiance affects the findings and representation of therapies that are considered efficacious. We argue that allegiance effects are evident in randomized controlled trials of supportive therapy. Supportive therapy is an established and bona-fide therapy but its implementation as a control group for non-specific elements is a treatment that does not resemble supportive therapy as would be used therapeutically. Allegiance effects in the use of supportive therapy are caused by the design of supportive therapy controls, the therapists who deliver supportive therapy, and the patients who are enrolled in the trials.

A meta-analysis was conducted to determine whether differences in efficacy exist among treatment approaches applied to youth. Included were all studies published between 1980 and 2005 involving participants 18 years of age or younger with diagnoses of depression, anxiety, conduct disorder, and attention-deficit/hyperactivity disorder that contained direct comparisons among two or more treatment methods intended to be therapeutic. Effect sizes were found to vary significantly, providing some evidence that differences in efficacy exist among treatments for these disorders in youth. However, the upper bound of the true difference in effects among treatments was small. Furthermore, researcher allegiance was found to be strongly associated with the difference in effect sizes so that when allegiance was controlled there was no evidence of any differences among treatments.

Increasingly, longitudinal multilevel models are being used to investigate change in psychotherapy. An issue related to these methods concerns how measurement error is modeled; one proposed model anchors patient trajectories on the initial observation, thereby assuming that the initial observation contains no error. Wampold and Bolt (2006) claimed that anchoring overestimates patient variability and consequently underestimates therapist effects. In this study, a simulation study was conducted to test this conjecture, and it was found that anchoring yields estimates of patient variability that are substantially higher than the actual variability and, therefore, therapist effects are underestimated.

The purpose of Kim, Wampold, and Bolt's (2005) analysis of the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (TDCRP) data was to estimate the pro...

Data for completer and intent-to-treat samples from the two psychotherapy conditions of the National Institute of Mental Health Treatment of Depression Collaborative Research Program were analyzed to estimate the proportion of variability in outcomes resulting from therapists. Therapists, who were nested within treatments, were considered a random factor in multilevel analyses. These analyses, which modeled therapist variability in several different ways, indicated that about 8% of the variance in outcomes was attributable to therapists, whereas 0% was due to the particular treatment delivered. When therapist effects were appropriately modeled, previously detected differences in efficacy between the two psychotherapy conditions for more severely depressed patients disappeared, as predicted by methodological considerations. Daten von vollstandigen Stichproben mit einer Behandlungsabsicht, von den beiden Psychotherapiebedingungen des gemeinsamen Forschungsprogramms des Nationalen Instituts fur psyc...

National discussions of health-care delivery systems have renewed the effort to identify empirically validated psychotherapies. Although the logic of efficacy studies in psychotherapy, which are used to empirically establish the efficacy of psychotherapy, is relatively simple, the validity of inferences from these studies are ambiguous and the focus on outcome obscures other important aspects of psychotherapy. Problems related to (a) common versus specific confounds, (b) difficulties in disproving the uniform efficacy supposition, and (c) hazards in standardizing treatments are discussed. These problems make developing criteria for establishing empirically validated treatments difficult; a currently proposed set of criteria for proving treatment efficacy is critiqued.Die in den USA gefuhrte Diskussion uber das System der Gesundheitsversorgung hat zur Erneuerung von Bemuhungen beigetragen, empirisch validierte Psychotherapien zu identifzieren. Obwohl die Logik von Effektivitatsstudien in der Psychotherapie...

The experience of bereavement is associated with emotional, physical, and spiritual distress. Much attention has been directed toward identifying demographic and social-support factors that affect response to loss. In contrast, little is known about the role of cognitive-behavioral coping strategies in bereavement adjustment. The purpose of this study was to investigate the impact of differential use of five cognitive-behavioral strategies on adjustment to bereavement: (a) attribution of personal maning to loss, (b) differentiation of grief resolution from devaluing the deceased loved one, (c) modulation of response to loss with other life activities, (d) identafication of predominant themes of distress, and (e) engagement in health-prmotion practices. It was hypothesized that the use of these strategies would significantly predict postmorbid adjustment over and above that predicted by demographic factors and/or social support. Measures designed to assess each variable were administered to 164 wi...

The study employed an ABA withdrawal design, replicated three times, with a control subject and a follow-up phase, to evaluate the effects of self-observation in reducing disruptive classroom behav...