This in‐session issue is focused on psychotherapists involved in and performing teamwork practices. Specifically, five teamwork‐based psychotherapy interventions are illustrated as solutions for ...complex clinical situations drawing from multiple theoretical approaches (narrative, systemic, cognitive behavioral, and integrative) and applied in different health care provision settings, ranging from psychotherapy private office to a multidisciplinary oncological service. The contributions try to cover a diversity of presenting problems: separating couples, gang involvement, schizophrenia, cancer and suicidal ideation, bipolar disorder; and formats of delivery such as couple therapy supervision, family therapy, multidisciplinary team formulation and interprofessional health psychology. Three main shared coordinates underlie the diversity of interventions: (1) Considering that psychotherapy is just a piece of a broader network of interactions and meanings generated around a given problem/solution and, thus, it is part of an ecology of ideas (ecological dimension), (2) Assuming interdependence and collaboration as the best strategies to interact with professionals and significant others involved with a given problem or solution (collaborative dimension), and (3) fostering a strengths‐based case formulation (epistemological dimension). The issue aims at enriching practitioners' toolbox willing to incorporate team‐based interventions as part of their range of professional competences.
IntroductionData-informed psychotherapy and routine outcome monitoring are growing as referents in psychotherapy research and practice. In Ecuador, standardised web-based routine outcome monitoring ...systems have not been used yet, precluding data-driven clinical decisions and service management. Hence, this project aims at fostering and disseminating practice-based evidence in psychotherapy in Ecuador by implementing a web-based routine outcome monitoring system in a university psychotherapy service.Methods and analysesThis is a protocol for an observational naturalistic longitudinal study. Progress and outcomes of treatment in the Centro de Psicología Aplicada of the Universidad de Las Américas in Quito, Ecuador will be examined. Participants will be adolescents and adults (≥11 years) seeking treatment, as well as therapists and trainees working at the centre between October 2022 and September 2025. Clients’ progress will be monitored by a range of key variables: psychological distress, ambivalence to change, family functioning, therapeutic alliance and life satisfaction. Sociodemographic information and satisfaction with treatment data will be collected before and at the end of treatment, respectively. Also, semi-structured interviews to explore therapists’ and trainees’ perceptions, expectations and experiences will be conducted. We will analyse first contact data, psychometrics of the measures, reliable and clinically significant change, outcome predictors as well as trajectories of changes. Moreover, we will conduct a framework analysis for the interviews.Ethics and disseminationThe protocol for this study was approved by the Human Research Ethics Committee of the Pontificia Universidad Católica del Ecuador (#PV-10–2022). The results will be disseminated in peer-reviewed scientific articles, at conferences and in workshops.Trial registration numberNCT05343741.
Objective: The aim of this study was to assess the resolution of cognitive conflicts (CCs) within a randomized controlled trial testing the differential efficacy of group cognitive behavioral therapy ...(CBT) plus an individually tailored intervention module focused on CCs vs. group plus individual CBT, and to determine whether CC resolution was related to improvement in symptoms and psychological distress. Methods: The data come from 104 adults meeting criteria for major depressive disorder and/or dysthymia. Change in scores on the Beck Depression Inventory-II and Clinical Outcomes in Routine Evaluation-Outcome Measure was assessed at the end of treatment and at three-month follow-up. Outcomes were compared between those participants who resolved their CCs and those who maintained them using three-level multilevel growth models. Results: CC resolution did not depend on treatment allocation. Participants who resolved their CCs acquired greater benefits with regards to reduction of depressive symptoms and psychological distress than those who maintained their conflicts. Conclusions: CC seems to be a relevant notion to take into consideration to understand symptom improvement. Further research on CC might lead to the advancement of treatments which involve conflict resolution as a change mechanism.
Several studies have researched how people can use the anonymity of the Internet to explore different aspects of their identity. There are many different platforms where one can create a “virtual ...self” by actively choosing how one presents themselves to others, and each one is designed with different characteristics depending on their purpose: from socialization to professional networking or even entertainment. Different studies have usually focused on specific platforms, but there is no one comparing how people construe their virtual self across different online environments. In this review, we aimed to synthesize research studies carried out about the construal of one’s identity within online platforms and how it can relate to different aspects of participants’ offline identity, such as their self-esteem or self-concept clarity. Data were gathered from 34 publications that researched this topic across different kinds of online platforms. We conducted a quality assessment and a narrative synthesis, reporting and comparing the main findings, as well as identifying possible gaps in the literature. Many studies have explored the idea of people creating either an idealized or accurate version of themselves when construing their online identities. Others have also contemplated the possibility of exploring identities that diverge from both the actual and the ideal self or even an actively negative one. The latter was studied more in the context of video games and other avatar-mediated worlds. We found that people with low self-esteem create a more idealized virtual identity rather than a virtual self that is similar to their offline self. Other variables such as the purpose for using the online platform or self-concept clarity also had a role in virtual self construal, although the latter was only studied in the context of social media.
Negative self-views have proved to be a consistent marker of vulnerability for depression. However, recent research has shown that a particular kind of cognitive conflict, implicative dilemma, is ...highly prevalent in depression. In this study, the relevance of these conflicts is assessed as compared to the cognitive model of depression of a negative view of the self. In so doing, 161 patients with major depression and 110 controls were assessed to explore negative self-construing (self-ideal discrepancy) and conflicts (implicative dilemmas), as well as severity of symptoms. Results showed specificity for the clinical group indicating a pattern of mixed positive and negative self-descriptions with a high rate of conflict. Regression analysis lent support to the conflict hypothesis in relation to clinically relevant indicators such as symptom severity, global functioning. However, self-ideal discrepancy was a stronger predictor of group membership. The findings showed the relevance of cognitive conflicts to compliment the well-consolidated theory of negative self-views. Clinical implications for designing interventions are discussed.
Cognitive behavioural therapy (CBT) is aimed to counteract cognitions and behaviours that are considered as dysfunctional. The aim of the study is to test whether the inclusion of a non-counteractive ...approach (dilemma-focused intervention, DFI) in combination with CBT group therapy will yield better short- and long-term outcomes than an intervention conducted entirely using CBT.
A total of 128 patients with depression and at least one cognitive conflict, of six health community centres in Barcelona, participated from November of 2011 to December of 2014 in seven weekly group CBT sessions and were then randomly allocated to either DFI or CBT (eight individual sessions each) by an independent researcher. Depressive symptoms were assessed with the Beck Depression Inventory-II at baseline, at the end of therapy and three- and twelve-month follow-ups. Therapists did not participate in any of the assessments nor in the randomisation of patients and evaluators were masked to group assignment. Both intention to treat and complete case analyses were performed using linear mixed models with random effects.
According to intention-to-treat analysis (F2, 179 = 0.69) and complete case analysis (F2, 146 = 0.88), both conditions similarly reduced the severity of symptoms across posttreatment assessments. For the 77 participants (CBTgroup +CBTindividual = 40; CBTgroup+DFIindividual = 37) that completed allocated treatment and one-year follow-up assessment, response and remission rates were relative higher for the DFI condition, however no significant differences were found between treatment conditions. The relapse rates were similar between treatment conditions (CBTgroup +CBTindividual = 7/20; CBTgroup+DFIindividual = 8/22).
Although using a counteractive approach across all the treatment sessions is quite effective, it does not seem to be necessary to produce significant improvement. DFI may be considered as an alternative, which could be included in a wider treatment for depression.
ClinicalTrials.gov; ID: NCT01542957.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Despite the burden associated to depression, current standards of care are still limited in scope and effectiveness. In addition, therapy outcomes have frequently focused solely on symptoms, leaving ...patients' wellbeing relatively unaddressed.
The objective of this study was to test whether two cognitive therapies increased subjective wellbeing in a sample of adults diagnosed with a depressive disorder, additionally assessing the relationship between this growth and decreases in both depression severity and psychological distress.
Data from 116 participants from a randomised controlled trial comparing the efficacy of cognitive behavioural therapy and dilemma-focused therapy were analysed. Multilevel linear models were employed, together with correlational analyses.
Results showed that both interventions significantly improved wellbeing with moderate to large effect sizes, while no significant differences were found between treatments. In turn, the increase in wellbeing was significantly associated to improvements in depression severity and psychological distress.
This study sheds light on the complex relationship between happiness and depression, supporting their conceptualisation as related yet independent human experiences, and strengthening subjective wellbeing as a useful outcome for psychological research. Psychotherapy is presented as an effective intervention to enhance wellbeing, even among individuals with severe depressive symptoms.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The improvement of psychological treatments for depression in young adults is a pressing issue highlighted in the literature. Its relevance is determined not only because young adults are ...underrepresented in research, but also to prevent chronic severe mental health disorders later in life. Engagement is considered a key factor for a good therapeutic outcome, especially among young patients. In this sense, virtual reality could be particularly suited to engage young adults in the therapy process. This project aims to improve the psychological treatment of mild-to-moderate depression in young adults by testing out the efficacy of virtual reality-enhanced personal construct therapy (PCT-VR), as compared to personal construct therapy alone (PCT) and to the reference standard cognitive behavioral therapy (CBT). In contrast to CBT, PCT neither educates patients about depression nor gives them directions on the changes to be made in their dysfunctional behaviors or cognitions. Rather, PCT explores the coherence (or conflicts) of thoughts and behaviors with respect to the person's sense of identity and focuses on meaning-making processes.
The efficacy of this innovative intervention (PCT-VR) will be compared to PCT and to CBT in a randomized clinical trial. The study includes an appraisal of therapists' adherence and independent assessments to preserve internal validity. The Beck Depression Inventory-II is the primary outcome measure for calculating both statistical and clinical significance, but other outcomes will also be assessed (e.g., functioning, well-being, anxiety, stress) at pre- and post-therapy and at 6-month follow-up. The trial will be conducted in a naturalistic context, mostly at the usual health care center of each patient. A sample of 225 participants is targeted to reach enough statistical power to accomplish the goals of the study.
We expect that providing evidence for PCT-VR will widen the repertoire of evidence-based technology-based psychotherapeutic interventions for young adults and contribute to the prevention of deteriorating courses of the disorder.
ClinicalTrials.gov NCT04321525 . Registered on 18 February 2020.
Objective: The aim of this study is to improve the understanding of self-changes after an intervention for depression focused on implicative dilemmas, a type of cognitive conflict related to ...identity. As recent research has highlighted the relevance of identity-related dilemmas in clients with depression, we sought to assess the way in which clients resolve such inner conflicts after a tailored dilemma-focused intervention and how this is reflected in the clients' self-narratives. Method: We used three instruments to observe differences between good (n = 5) and poor (n = 5) outcome cases: (i) the Repertory Grid Technique to track the resolution of dilemmas, (ii) the Change Interview to compile clients' accounts of changes at posttreatment, and (iii) the Innovative Moments Coding System to examine the emergence of clients' novelties at the Change Interview. Results: Groups did not differ in terms of the number and relevance of client-identified significantly helpful events. However, between-group differences were found for the resolution of dilemmas and for the proportion of high-level innovative moment (IM) types. Furthermore, a greater self-narrative reconstruction was associated with higher levels of symptom improvement. Conclusions: Good outcome cases seem to be associated with the resolution of conflicts and high-level IMs.
The objective of this paper is to assess the reliability and validity of the Spanish translation of the Clinical Outcomes in Routine Evaluation - Outcome Measure, a 34-item self-report questionnaire ...that measures the client's status in the domains of Subjective well-being, Problems/Symptoms, Life functioning, and Risk.
Six hundred and forty-four adult participants were included in two samples: the clinical sample (n=192) from different mental health and primary care centers; and the nonclinical sample (n=452), which included a student and a community sample.
The questionnaire showed good acceptability and internal consistency, appropriate test-retest reliability, and acceptable convergent validity. Strong differentiation between clinical and nonclinical samples was found. As expected, the Risk domain had different characteristics than other domains, but all findings were comparable with the UK referential data. Cutoff scores were calculated for clinical significant change assessment.
The Spanish version of the Clinical Outcomes in Routine Evaluation - Outcome Measure showed acceptable psychometric properties, providing support for using the questionnaire for monitoring the progress of Spanish-speaking psychotherapy clients.
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