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BACKGROUND: Managing Cancer and Living Meaningfully (CALM) is an evidence-based, brief, semi-structured psychotherapy designed to help patients with advanced cancer cope with the practical and profound challenges of their illness. However, no study to date has investigated its feasibility, acceptability, and preliminary effectiveness in adults with malignant glioma, despite the well-documented incidence of psychological distress in this vulnerable and underserved population. METHODS: Fourteen patients with glioma and elevated symptoms of depression and/or death anxiety enrolled in the trial: 83% glioblastoma, 75% female, M(age) = 56 years (SD = 15.1; range = 27–81). Feasibility was assessed based on established metrics. Acceptability was measured by post-session surveys and post-intervention interviews. Preliminary intervention effects were explored using paired t-tests, comparing psychological distress at baseline and post-intervention. RESULTS: Of the 14 enrolled patients, 12 were evaluable. Nine completed the study (75% retention rate). Three patients withdrew due to substantial disease progression which affected their ability to participate. Participants reported high perceived benefit, and all recommended the program to others. Baseline to post-intervention assessments indicated reductions in death anxiety, generalized anxiety, and depression, and increases in spirituality. Quality of life and fear of cancer recurrence remained stable throughout the study period. CONCLUSIONS: CALM appears feasible for use with adults with malignant glioma. Enrollment and retention rates were high and comparable to psychotherapy trials for patients with advanced cancer. High perceived benefit and reductions in symptoms of death anxiety, generalized anxiety, and depression were reported by participants. These findings are extremely encouraging and support further study of CALM in neuro-oncology.

Background Young people account for more than a quarter of new HIV infections in the US, with the majority of cases among young men who have sex with men; young transgender women are also vulnerable to infection. Substance use, particularly alcohol misuse, is a driver of sexual transmission and a potential barrier to engagement in the HIV prevention and care continuum, however vulnerable youth are difficult to reach for substance use services due, in part, to complex social and structural factors and limited access to health care. The Community Prevention Services Task Force recommends electronic screening and brief intervention as an evidence-based intervention for the prevention of excessive alcohol consumption; however, no prior studies have extended this model to community-based populations of youth that are susceptible to HIV infection. This paper describes the study protocol for an electronic screening and brief intervention to reduce alcohol misuse among adolescents and young adults vulnerable to HIV infection in community-based settings. Methods This study, Step Up, Test Up, is a randomized controlled trial of an electronic alcohol screening and brief intervention among youth, ages 16–25, who are vulnerable to HIV infection. Individuals who present for HIV testing at one of three community-based locations are recruited for study participation. Eligibility includes those aged 16–25 years, HIV-negative or unknown HIV status, male or trans female with a history of sex with men, and English-speaking. Participants who screen at moderate to high risk for alcohol misuse on the Alcohol Use Disorders Identification Test (AUDIT) are randomized (1:1) to either an electronic brief intervention to reduce alcohol misuse or a time-and attention-matched control. The primary outcome is change in the frequency/quantity of recent alcohol use at 1, 3, 6 and 12-month follow-up. Discussion Testing of evidence-based interventions to reduce alcohol misuse among youth vulnerable to HIV infection are needed. This study will provide evidence to determine feasibility and efficacy of a brief electronically-delivered intervention to reduce alcohol misuse for this population. Trial registration ClinicalTrials.gov number, NCT02703116, registered March 9, 2016.

Background Alcohol-exposed pregnancy (AEP) is an ongoing concern, especially within low-resource, high-risk areas such as rural American Indian/Alaska Native (AIAN) communities. Brief, preconceptual AEP-reduction interventions are popular in such areas but have a small impact on alcohol use. Developing a strategic alcohol change plan is a key program component; however, there is little research on strategy selection, especially within contexts that positively or negatively impact selection (e.g., cultural strengths, trauma, collective efficacy within AIAN communities). This study qualitatively analyzed strategies chosen to reduce alcohol use by AIAN women participating in a culturally tailored, brief, preconceptual AEP-reduction intervention. Methods One hundred-sixty Northern Plains AIAN women who were participating in a brief AEP-reduction program developed a plan to accomplish an alcohol reduction/abstention goal at the first and last program sessions. The plan included choosing 1 or more strategies to (1) achieve the goal, (2) mitigate barriers, and (3) use cultural strengths. Qualitative analysis of the data involved thematic open and structured coding of all 3 strategies separately. We also examined how many different themes (different individual strategies) participants reported for each strategy component. Results Most participants reported only 1 strategy (theme) for each of the 3 components. Common goal-achieving and barrier-mitigation strategies included positive social supports and avoiding negative or alcohol-involved social environments. Other strategies involved circular logic (e.g., the strategy to reduce drinking was to drink less). Both traditional and western cultural strengths were reported as important resources, although many participants had no cultural resource strategy. Conclusion Programs aimed at reducing AEPs may need to provide participants more support to develop strong strategies to reduce alcohol use when implemented within areas with high levels of trauma and contextual barriers that can impact strategy selection. Such support could include ways to improve health on both interpersonal and community levels.

A commonly stated critique of Solution Focused Brief Therapy (SFBT) is a lack of attention to the client's emotional experience and the use of emotion as a mechanism for producing meaningful change. We review and define the current research regarding emotion, feeling, and affect and its value and relevance to the clinical application of SFBT. We also provide a brief history of the SFBT model and its documented emphasis on cognitive and behavioral change versus emotional change. In embodying the spirit of this approach for examining what works and doing more of it, we propose a next step of SFBT to more overtly attend to the emotional language of clients and to purposefully create emotional experiences with our clients. We demonstrate this by providing clinical examples for how SFBT practitioners can incorporate and build upon clients' emotional language to create emotionally-changing experiences to more broadly and effectively co-create long-lasting change.

Self-compassion interventions have been suggested as a potentially more acceptable way to address body image distress compared to interventions that emphasize challenging (often firmly entrenched) thin-ideals. In the current randomized controlled trial, young adult women endorsing body image concerns were randomized to a self-compassion (SC) intervention consisting of one in-person session plus one week of self-guided practice (n = 50), a similarly-structured dissonance-based (DB) intervention (n = 50), or a waitlist (WL) control (n = 51). Both brief interventions were acceptable and were more effective than WL. The two interventions did not differ significantly from each other in reducing the global measure of body dissatisfaction, improving body appreciation, or reducing appearance-contingent self-worth. The DB intervention alone decreased thin-ideal internalization, but only among participants with initially high scores. More participants initially expressed a preference for the SC rationale, and at post-test SC participants reported a higher likelihood of recommending the intervention they had received to others. Change in self-compassion emerged as a possible mechanism of action within both interventions, suggesting it may be useful to integrate aspects of both approaches to enhance acceptability and provide the greatest benefits.

Intensive short-term dynamic therapy (ISTDP) is an evidence-based psychotherapy supported by a growing literature base. "Unlocking" of the unconscious is a central process in ISTDP. This study sought to operationalize the concept of unlocking by adopting a detailed process analysis of the early phase of therapy for four patients by using a structured measure, the Achievement of Therapeutic Objectives Scale (ATOS).The ATOS is a measure of psychotherapy processes. A profile of the scale's cutoff scores was developed to identify episodes of unlocking in videos of 28 ISTDP therapy sessions. Expert raters assessed for episodes of unlocking for up to the first 10 recorded psychotherapy sessions of four participants in a naturalistic private practice setting. Sessions were then rated with the ATOS profile, and these ratings were compared with expert ratings to assess the sensitivity of the ATOS in identifying episodes of unlocking.Using the profile of subscale cutoff scores, the ATOS successfully identified seven of 11 episodes of unlocking. A visual analysis of descriptive data indicated that average ATOS subscale scores consistently identified episodes of unlocking and the presence of complex feelings of rage and guilt about the rage. Expert ratings of unlocking and the ATOS ratings were found to have high interrater reliability.This pilot study suggests that the ATOS may be adapted to provide a profile that can identify episodes of unlocking of the unconscious. The proposed measure is worthy of further study, representing an initial step toward operationalizing a central process associated with positive outcomes in ISTDP.

Over the years, short term psychodynamic therapy (STPP) has been broadly researched in order to evaluate its efficacy in the treatment of major psychiatric disorders. In particular, a consistent number of studies focused on assessing clinical outcomes of the principal psychodynamic techniques in treating depressive disorders. We conducted a narrative review in which we aimed to evaluate the efficacy of STPP in monotherapy in major depressive disorder and to assess possible features that may correlate with its clinical use. Databases searched were PubMed, Ovid, Scopus, PsycINFO and Cochrane Libraries from inception to July 2022. Our research underlined that STPP in monotherapy is particularly effective in moderately severe depression and in preventing depressive relapses. Moreover, a case-by-case evaluation of its efficacy should be performed when considering STPP for the treatment of major depression with other comorbid psychiatric conditions. Although such key points emerged from scientific evidence, STPP should be better studied in the long-term perspective; further research is needed to define the clinical scenarios in which STPP can be considered a first-line approach as monotherapy in major depressive disorder compared to medications or other types of psychotherapy.

Given the negative impacts of the COVID-19 pandemic on the population's mental health, scientific research that evaluates the effectiveness of psychological support services has become relevant. This study assessed the effect of brief online therapy on participants assisted by the extension project "Psychological Support – COVID19" . The procedure consisted of offering one to four sessions of brief online therapy to participants of both sexes, aged between 20 and 70. Participants were health professionals, infected people or their relatives, and professionals from other areas, such as police staff and teachers. The Outcome Questionnaire (OQ-45) and the Hospital Anxiety and Depression Scale (HADS) were applied in three stages: pre-intervention, post-intervention, and follow-up (average of 2 months after post-intervention). Participants reported lower anxiety (HADS) and "subjective discomfort" (OQ45), but the effect on depression (HADS) and on "interpersonal relationships", and "social role performance" (OQ45) was not significant. We concluded that the psychological support offered by the Project effectively reduced anxiety and subjective discomfort. Also, free, and accessible services to the population are necessary for crises since the psychological effects of the COVID-19 pandemic affected health professionals and the general population. Dados los impactos negativos de la pandemia de COVID-19 en la salud mental de la población, la investigación científica para evaluar la efectividad de los servicios de apoyo psicológico ha cobrado relevancia. Este estudio evaluó el efecto de una terapia breve online en participantes asistidos por el proyecto de extensión “Apoio Psicológico – COVID19”. El procedimiento consistió en ofrecer de una a cuatro sesiones de terapia breve online a participantes de ambos sexos, con edades comprendidas entre los 20 y los 70 años. Participaron profesionales de la salud, contagiados o familiares de contagiados y profesionales de otras áreas, como policías y docentes. Se aplicó el Outcome Questionnaire (OQ-45) y la Hospital Anxiety and Depression Scale (Hospital Anxiety and Depression Scale - HADS) en tres etapas: preintervención, postintervención y seguimiento (2 meses en promedio después de la postintervención). Los participantes informaron una reducción de la ansiedad (HADS) y el "malestar subjetivo" (OQ45), pero el efecto sobre la depresión (HADS), las "relaciones interpersonales" y el "desempeño del rol social" (OQ45) no fueron significativos. Se concluyó que el apoyo psicológico ofrecido por el Proyecto redujo la ansiedad y el malestar subjetivo y que los servicios gratuitos y accesibles a la población son necesarios en tiempos de crisis, ya que los efectos psicológicos derivados de la pandemia del COVID-19 afectaron a los profesionales de la salud y a la población en general. Diante dos impactos negativos da pandemia de COVID-19 na saúde mental da população, tornou-se relevante a pesquisa científica que avalie a eficácia dos serviços de apoio psicológico. Este estudo avaliou o efeito de uma terapia breve on-line em participantes assistidos pelo projeto de extensão “Apoio Psicológico – COVID19”. O procedimento consistiu em oferecer de uma a quatro sessões de terapia breve on-line a participantes de ambos os sexos, com idade entre 20 e 70 anos. Participaram profissionais da saúde, infectados ou familiares de infectados e profissionais de outras áreas, como policiais e professores. O Outcome Questionnaire (OQ-45) e a Escala Hospitalar de Ansiedade e Depressão (Hospital Anxiety and Depression Scale - HADS) foram aplicados em três etapas: pré-intervenção, pós-intervenção e follow-up (2 meses em média após a pós-intervenção). Os participantes relataram redução da ansiedade (HADS) e do “desconforto subjetivo” (OQ45), mas o efeito sobre a depressão (HADS), as “relações interpessoais” e o “desempenho de papéis sociais” (OQ45) não foram significativos. Concluiu-se que o apoio psicológico oferecido pelo Projeto reduziu a ansiedade e o desconforto subjetivo. Além disso, conclui-se que serviços gratuitos e acessíveis à população são necessários em momentos de crise, pois os efeitos psicológicos decorrentes da pandemia do COVID-19 afetaram os profissionais de saúde e a população em geral.

This exploratory study assesses the use and quality of therapeutic immediacy in short-term psychodynamic psychotherapy for depression. We aimed to identify what constitutes effective here-and-now discussions of the therapeutic relationship by examining a sample of four treatment cases drawn from a previous randomized clinical trial for depression. Transcripts of 16 treatment sessions (four time points per treatment) were analyzed using the consensual qualitative research for case study method. The therapists' contributions to therapeutic immediacy were assessed qualitatively by independent judges and then quantitatively analyzed in relation to immediate session outcome as well as overall treatment outcome (reduction in depressive symptoms). A total of 41 immediacy events were identified across 16 sessions, of which 35 were therapist-initiated and subsequently organized into 18 discrete categories. High-quality immediacy events (as assessed by the judges) were associated with higher patient involvement. Two immediacy categories were significantly different between good and poor outcome cases. Therapists "acknowledged their patient's progress in therapy" more often in good outcome cases, whereas they "assessed patients' feelings about the overall progress of therapy" more often in poor outcome cases. No significant relationship was found between frequency, rated quality of immediacy events, and treatment outcome. Four immediacy events rated by the judges as high- and low-quality are presented as clinical examples illustrating positive and negative therapists' contributions to therapeutic immediacy. Therapist behaviors that may improve the effectiveness of therapeutic immediacy are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

There are different types of psychotherapy for anxiety, depression, and personality disorders with comparable effect. This review describes the theory, methods, and evidence of psychodynamic short-term therapy. After a description of nuances in the dominant tendencies, the common elements of the therapy are summarised. The therapeutic question is which treatment works best for which patient under which circumstances. In this context, psychodynamic short-term therapy must be part of a continuum of treatment options, adapted to the patients' personal characteristics, needs, and wishes.

A significant proportion of adolescents suffering from major depressive disorder (MDD) are likely to have a co-morbid personality disorder (PD). Short-term psychoanalytic psychotherapy (STPP) was found to be one treatment of choice for adolescents suffering from MDD. Background: The first experimental study of transference work-in teenagers (FEST-IT) demonstrated the efficaciousness of transference work in STPP with adolescents suffering from MDD. The usefulness of STPP may be enhanced by exploring possible moderators. Methods: Depressed adolescents (N = 69), aged 16–18 years, were diagnosed with the structured interview for DSM-IV PDs and randomized to 28 weeks of STPP with or without transference work. A mixed linear model was applied. The moderator effect was investigated by a three-way interaction including “time”, “treatment group” and “number of PD criteria”. Results: A small but significant moderator effect was found for cluster B personality pathology. Patients with a higher number of cluster B PD criteria at baseline did better up to one-year post-treatment where therapists encouraged patients to explore the patient–therapist relationship in the here and now. Conclusion: When treated with psychoanalytic psychotherapy for MDD, adolescents with cluster B PD symptoms seem to profit more from transference work than adolescents without such pathology.

The bio-psycho-social model highlights intra-individual and inter-individual interactions, including psychotherapy. The processing of these interactions within a person takes place, among others, in the central autonomic network (CAN). The CAN's autonomic output to the periphery can be indexed by heart rate variability (HRV), representing individual adaptive capacity. Further, the CAN influences the hypothalamus-pituitary-adrenal axis with its product cortisol. The aim consisted in investigating HRV and cortisol as well as their relation to symptom course in response to short-term psychotherapy. A single-arm, uncontrolled, explorative study was conducted at an outpatient psychotherapeutic consultation in the workplace offered to employees with mental or psychosomatic complaints. Questionnaires included symptoms of depression, irritation and functional impairment. Circadian profile of HRV and salivary cortisol concentrations collected pre and post short-term psychotherapeutic intervention (4-12 sessions) were assessed. Multilevel-linear mixed regressions were calculated. Out of 29 participants (mean age 42; 72% female), 24% were on sick leave from work. Cortisol concentrations were neither affected by intervention nor by symptom course. The proportion of individuals showing a vagally mediated HRV in the range of the lowest quartile assessed for age- and sex-matched healthy controls was reduced at follow-up (pre 34%, post 22%; p = .017). Higher vagally mediated HRV at baseline predicted lower symptom burden at follow-up. Thus, the results support the assumption that HRV reflects the capability of an organism to adapt and recover. Patients with reduced HRV might need additional psychotherapeutic sessions to achieve the same symptom improvements than patients with retained HRV.

The need for clinical approaches that address romantic relationship concerns of adults with autism spectrum disorder (ASD) has been essentially overlooked. There are a growing number of recommendations in the available literature to increase the availability and evaluation of treatment approaches that are appropriate for couples that include an adult with ASD. The aim of the present study was to explore clinical outcomes of a neurodiverse couple who participated in twelve sessions of solution-focused brief therapy. Our findings indicated both partners experienced improvement in the target complaints, communication and emotional awareness. On the other hand, each partner had a different trajectory of change in relationship satisfaction over the course of treatment. Directions for future research and implications for couple therapy with adults diagnosed with ASD are discussed.

Crisis intervention psychotherapy (CIP) is an underutilized form of therapy that can be offered as a treatment during psychiatric disasters and emergencies, and it may be especially useful during the age of Coronavirus Disease 2019 (COVID-19). CIP is a problem-solving, solution-focused, trauma-informed treatment, utilizing an individual or systemic/family-centered approach. CIP is a brief form of psychotherapy delivered as a companion or follow-up to psychological first aid. Crisis psychotherapy is designed to resolve a crisis and restore daily functioning. CIP can be adapted as a single session for a COVID-19 mental health emergency or for a hotline or as 2 to 20 sessions of treatment with COVID-19 patients and families offered virtually on a psychiatric inpatient unit, through a consultation-liaison service, or in outpatient settings. This article reviews the history of critical incident stress management and the use of its replacement, psychological first aid. The history and core principles of crisis psychotherapy and 8 core elements of treatment are described. The use of digital and virtual technology has enabled the delivery of crisis psychotherapy during the COVID-19 pandemic. A case study of a family impacted by COVID-19 is reported as an illustration. The use of a 6-week timeline, an ecological map, and a problem-solving wheel-and-spoke treatment plan are demonstrated.

Substance use is a prevalent public health issue. Most social workers may encounter substance use in their work with clients and need effective therapeutic strategies for this issue. Since the 1980s, solution-focused brief therapy (SFBT) has been practiced with clients who have substance use problems, and clinical training materials have been developed to help practitioners learn and use SFBT in substance use treatment. Despite the longevity of the use of SFBT in practice, there are no published reviews of outcome studies to guide practitioners using SFBT. This article fills a gap in current literature on SFBT and substance use treatment by reviewing the published studies on SFBT where the focus was on substance use treatment. Five databases were searched to identify eligible studies. Experts and reference lists of relevant studies were also consulted. Nine studies were identified and included in the review. All studies reviewed found promising evidence on SFBT’s effectiveness in improving substance use behaviors and related psychosocial problems. Five of the nine studies reviewed showed that SFBT can change substance use and comorbid mental health and psychosocial problems such as depression, trauma, and school- and work-related behavior problems. The article concludes with a discussion of the study results’ implications for clinical practice and future research.

The aim of this study was to identify and explore mediators of psychodynamic-interpersonal psychotherapy (PIT) on treatment outcome in multisomatoform disorders (MSD).Data from 164 patients with MSD who took part in a randomized control trial of PIT (Stress partially mediated the effect of PIT vs. EMC on the follow-up outcome. PIT (as compared to EMC) led to lower post-treatment stress-levels, which in turn led to higher physical quality of life at follow-up. Neither depression nor the alliance had a mediating effect.Stress mediated the outcome of PIT for MSD. Future studies are needed to extend the scope of research regarding which specific psychotherapeutic mechanisms of change are beneficial in PIT treatment of MSD patients.

Social anxiety (SA) is implicated in problematic undergraduate drinking. Brief motivational interventions (BMIs) reduce problematic undergraduate drinking. However, not all students benefit. Identification of vulnerable subgroups is an important next step. The current study examined the role of SA and protective behavioral strategies (PBS) on BMI outcomes. We reanalyzed a subset of data (53.3%; N = 120; 62.5% male) from a randomized trial in which heavy drinking undergraduates were randomized to a BMI or control. SA, past-month typical drinks, peak drinks, weekly quantity, alcohol problems, and PBS were assessed at baseline and 6 weeks. Main effects and interaction among the intervention condition (BMI vs. control) and SA group (low vs. high) were tested on alcohol outcomes and PBS. High SA undergraduates reported greater baseline drinking, more alcohol problems, and lower PBS. Post-BMI, high SA drinkers continued to report greater peak drinks, typical drinks, alcohol problems, and lower PBS use, controlling for baseline use. Among the BMI condition, parallel multiple mediation analyses revealed the PBS subscale Manner of Drinking uniquely mediated the relationship between SA and heavier post-BMI drinking. The PBS Manner of Drinking and Serious Harm Reduction subscales jointly mediated the relationship between SA and greater post-BMI alcohol problems. BMIs may need to be refined to improve outcomes for socially anxious drinkers. Increasing PBS utilization post-BMI may help improve BMI efficacy in this vulnerable group. Clinical implications are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Contains fulltext : 236781.pdf (Publisher’s version ) (Closed access) Short-term psychodynamic psychotherapy (STPP) is an empirically supported treatment for depression that is frequently applied in clinical practice. However, it remains largely unclear which patients can benefit specifically from STPP for depression, because studies often have small sample sizes and, therefore, lack statistical power to examine patient characteristics associated with differential treatment efficacy. Individual participant data (IPD) meta-analyses, which combine patient-level data from multiple studies, can help overcome this obstacle. Currently, the first IPD meta-analysis project regarding STPP for depression is being conducted. We describe this project, its progress, and first findings. 5 p.

Predicting the trajectories of alliance formation that the patient is likely to establish with the therapist during treatment, even before their first meeting, can help prevent the potentially harmful consequences of deterioration in alliance, such as poor outcome and premature dropout. The present study aimed to examine the ability of four pretreatment acoustic markers to predict the alliance that is likely to be formed in the course of treatment: F0 span, speech rate, pause proportion and jitter. Data from 560 observations of 38 patients were collected as part of an ongoing randomized clinical trial of short-term psychotherapy for major depressive disorder. The acoustic markers were measured using high-quality recordings at baseline, before the patient and therapist ever met or had any type of communication. A multilevel model was used to examine the ability of the four acoustic markers to predict the slopes of alliance formation in the course of treatment, all markers being introduced in the same model. The clinical utility of the acoustic markers was explored in two case studies. The model explained 22% of the variance in alliance formation. Higher levels of both jitter and pause proportion at baseline predicted less strengthening of the alliance in the course of treatment. The findings, which should be replicated in larger samples, suggest that much of the therapeutic alliance can be predicted based on the acoustic characteristics of the patient's voice in the first 3 min of their intake, before they even meet their therapist.

Cystic fibrosis (CF) presents with various symptoms that impair day-to-day functioning and require lifelong treatment. Due to the chronic and severe nature of this disease, families are often impacted by the stress associated with treatment, complications of the disease, and the understanding that their loved one will one day die from CF. This article seeks to address a perceived gap in the literature for providing a model-specific approach to address psychosocial stress in families affected by CF. We provide a rationale for using solution-focused brief therapy (SFBT) to work with this population based on its empirically supported effectiveness, versatility, and capacity to be brief in nature. We describe how SFBT interventions can be used by practitioners working with this population, present a fictitious case illustration depicting the clinical use of specific SFBT interventions, and offer suggestions for future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

therapeutic alliance consistently predicts dropout from psychological therapy, and ruptures in the therapeutic alliance may also predict dropout, yet there is a dearth\ud of research with adolescents. This study investigated whether markers of rupturerepair in the therapeutic alliance were indicative of different types of treatment ending in adolescents who received psychological treatment for depression. Data were from the IMPACT study, a trial investigating the effectiveness of therapies for adolescent depression. Participants were randomly allocated to receive a psychological therapy: Brief Psychosocial Intervention, Cognitive-Behavioural Therapy or Short-Term Psychoanalytic Psychotherapy. The sample (N=35) comprised adolescents who had either completed their treatment (n=14) or dropped out (n=21) according to their therapist. Dropout cases were further classified as dissatisfied (n=14) or got-whatthey-\ud needed (n=7) based on post-therapy interviews with the adolescent and therapist. Selected audio-recordings of therapy sessions were rated using the Rupture Resolution Rating System and Working Alliance Inventory (observer-version). Therapeutic alliance and rupture-repair during therapy were similar for completers and got-what-they-needed dropouts, while dissatisfied dropouts had poorer\ud therapeutic alliance, more ruptures, ruptures were frequently unresolved, and therapists contributed to ruptures to a greater extent. Qualitative analysis of the sessions led to the construction of three categories of therapist contribution to\ud ruptures: therapist minimal response; persisting with a therapeutic activity; and focus on risk. Results suggest that ruptures, especially when unresolved, could be regarded\ud as warning signs of disengagement and dropout from psychological treatment. Future research should investigate how ruptures may be effectively identified and resolved in\ud treatment with adolescents.

With advances in medical treatment and an aging population, there is an increasing global burden of advanced and life-limiting illnesses. Individuals living with these conditions may experience substantial distress related to disease progression, changes in important roles and life goals, loss of meaning, and uncertainty about the future, but there has been limited evidence to inform their psychotherapeutic care. Managing cancer and living meaningfully (CALM) therapy is a brief, evidence-based, semistructured intervention that provides a framework to address practical issues, such as navigating the health care system and treatment decisions, and existential issues, including finding meaning and hope in the face of mortality. CALM has been shown to alleviate and prevent depression and to facilitate preparation for the end of life among patients with advanced cancer. It is being adapted to other life-threatening illnesses and different cultural contexts and health care settings. Advocacy is needed to support such approaches for individuals living with advanced and life-threatening illness.

The aim of this naturalistic process study was to investigate the relationship between emotional clarity and tolerance of emotional distress and depressive symptoms over the course of short-term psychodynamic psychotherapy for chronically depressed patients.Weekly self-reports of emotional clarity, tolerance of emotional distress, and depressive symptoms (PHQ-9) were provided by 252 patients with chronic depression who were admitted to a 13-week inpatient treatment program. Latent curve modeling with structured residuals (LCM-SR) was applied to investigate the between- and within-person effects of week-to-week change in emotional clarity and tolerance of emotional distress as predictors of subsequent depression. The relationship between emotional clarity and tolerance of emotional distress was also investigated.At the within-person level, higher level of emotional clarity and tolerance of emotional distress predicted subsequent lower level of depression. A reciprocal relationship was found for tolerance of emotional distress (lower level of depression predicted subsequent level of tolerance emotional distress) but not for emotional clarity. No within-person effect between emotional clarity and tolerance of emotional distress was found.The results indicate that emotional clarity and tolerance of emotional distress may be mechanisms of change in short-term psychodynamic psychotherapy for chronic depression. The results are consistent with previous findings of the importance of emotional clarity and tolerance of emotional distress in psychotherapy. This study demonstrated the utility of LCM-SR as a method to identity mechanisms of change in psychotherapy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background and Objectives: Many residency programs provide alcohol and drug screening, brief intervention (BI), and referral to treatment (SBIRT) training, hoping to impact residents’ future practice activities. Little is known about postresidency use of these skills. This study assesses postresidency impact of SBIRT training. Methods: Over 3 years, physicians who participated in SBIRT training in four residency programs were recruited for follow-up. Participants chose between a paper and online questionnaire 12-24 months after graduation; participants received $20 gift cards. We first analyzed postresidency responses only (n=74), then compared pre- and posttraining results of those completing both surveys (n=50). Results: Of 182 enrolled graduates, 74 (41%) completed questionnaires. In paired comparisons to their pretraining responses, graduates increased endorsement of statements that BIs can reduce risky use and reduced endorsement of statements that they do not have adequate training or time to address patients’ alcohol use, or that discussing alcohol use with patients is uncomfortable. While most barriers to providing interventions were endorsed less frequently by SBIRT-trained clinicians in postresidency surveys, ongoing concerns included poor reimbursement, little time, low success rates, and some discomfort with interventions. Seventy percent of graduates felt motivational interviewing techniques created stronger doctor-patient relationships; 16% reported colleagues in their practices had increased SBIRT activities after they joined the practice. Conclusions: SBIRT trainees reported high levels of SBIRT activity 12-24 months after graduation and increased SBIRT activities by their colleagues. While some barriers remain, residency training appears to be a promising approach for disseminating SBIRT into clinical practice.

Supportive psychotherapy has long had an undeservedly weak reputation. This review aims to describe the use of manualized, time-limited brief supportive psychotherapy (BSP) and its testing in clinical trials across three decades. Although numerous clinical descriptions of supportive psychotherapy exist, its use is reportedly widespread, and several supportive psychotherapies have been used in psychotherapy trials, BSP is the first and sole supportive psychotherapy manualized for research. BSP was designed as a nondirective, affect-focused, bare-bones common-factors treatment.Collecting data from the nine randomized controlled trials involving BSP, eight of them published, the author presents a narrative summary of findings.Eight trials addressed mood disorders and one addressed social anxiety disorder. Sample size varied. Most BSP trials resulted in "dead heat" comparable outcomes. BSP generally showed large effect sizes for improvement on the primary outcome variable (range d=0.62-1.01). Delivering it won over some therapists from exposure-based backgrounds.Despite its perennial role as an unfavored control condition, BSP held its own in competition with more symptom-focused therapies, usually producing a dead-heat outcome. The findings indicate the importance of psychotherapeutic common factors and the potency of BSP as an active treatment condition.