Objective: Little is known about the temporal variability of the alliance-symptom change and cohesion-symptom change relationships over the course of group therapy. These questions were examined in a ...sample of 373 clients receiving a transdiagnostic cognitive behavior therapy (tCBT), which culled the principle research-supported mechanisms of change for anxiety disorders. Method: The authors examined relationships between the client versions of the Working Alliance Inventory and Group Cohesion Scale in predicting subsequent symptom change, as assessed by the state scale of the State-Trait Anxiety Inventory. Results: Alliance and cohesion were significant predictors of next session anxiety scores. The alliance was consistently associated with anxiety symptoms (rs = −.152 to −.198, ps < .05), but cohesion only showed significant relationships with anxiety symptoms at Sessions 8 and 10 (Session 8, r = −.233, p = .020, and 10, r = −.236, p = .027). Alliance-anxiety relations remained constant, whereas cohesion-anxiety relations substantially increased from earlier to later sessions. Discussion: Differences that were obtained in the relation of alliance and cohesion with anxiety symptoms suggests that these processes have different roles within group tCBT. If replicated, the present findings would suggest that the dynamic relationships between alliance and cohesion and symptoms within group CBT for anxiety disorders have been an important omission in process-outcome studies.
What is the public health significance of this article?
This study strongly suggests that the relationships between therapist alliance and group CBT outcomes remains consistent. The influence of group cohesiveness on group therapy outcomes increases later in treatment.
Chronic depression is a highly prevalent and disabling disorder. There is a recognized need to assess the value of long-term disorder-specific psychotherapy.
To evaluate the efficacy of the Cognitive ...Behavioral Analysis System of Psychotherapy (CBASP) compared with that of nonspecific supportive psychotherapy (SP).
A prospective, multicenter, evaluator-blinded, randomized clinical trial was conducted among adult outpatients with early-onset chronic depression who were not taking antidepressant medication. Patients were recruited between March 5, 2010, and October 16, 2012; the last patient finished treatment on October 14, 2013. Data analysis was conducted from March 5, 2014, to October 27, 2016.
The treatment included 24 sessions of CBASP or SP for 20 weeks in the acute phase, followed by 8 continuation sessions during the next 28 weeks.
The primary outcome was symptom severity after 20 weeks (blinded observer ratings) as assessed by the 24-item Hamilton Rating Scale for Depression (HRSD-24). Secondary outcomes were rates of response (reduction in HRSD-24 score of ≥50% from baseline) and remission (HRSD-24 score ≤8), as well as self-assessed ratings of depression, global functioning, and quality of life.
Among 622 patients assessed for eligibility, 268 were randomized: 137 to CBASP (96 women 70.1% and 41 men 29.9%; mean SD age, 44.7 12.1 years) and 131 to SP (81 women 61.8% and 50 men 38.2%; mean SD age, 45.2 11.6 years). The mean (SD) baseline HRSD-24 scores of 27.15 (5.49) in the CBASP group and 27.05 (5.74) in the SP group improved to 17.19 (10.01) and 20.39 (9.65), respectively, after 20 weeks, with a significant adjusted mean difference of -2.51 (95% CI, -4.16 to -0.86; P = .003) and a Cohen d of 0.31 in favor of CBASP. After 48 weeks, the HRSD-24 mean (SD) scores were 14.00 (9.72) for CBASP and 16.49 (9.96) for SP, with an adjusted difference of -3.13 (95% CI, -5.01 to -1.25; P = .001) and a Cohen d of 0.39. Patients undergoing CBASP were more likely to reach response (48 of 124 38.7% vs 27 of 111 24.3%; adjusted odds ratio, 2.02; 95% CI, 1.09 to 3.73; P = .03) or remission (27 of 124 21.8% vs 14 of 111 12.6%; adjusted odds ratio, 3.55; 95% CI, 1.61 to 7.85; P = .002) after 20 weeks. Patients undergoing CBASP showed significant advantages in most other secondary outcomes.
Highly structured specific psychotherapy was moderately more effective than nonspecific therapy in outpatients with early-onset chronic depression who were not taking antidepressant medication. Adding an extended phase to acute psychotherapy seems promising in this population.
clinicaltrials.gov Identifier: NCT00970437.
The therapeutic value of alliance is a contested supposition. Although many theorists and researchers believe that alliance is therapeutic in itself, others see it as a byproduct of effective ...treatment or as a common nonspecific factor enabling the truly effective ingredients of treatment to work. For many years, the debate was confined mainly to the domain of theory, and no studies were available to confirm which of these approaches is correct. The only empirical evidence that existed was studies showing a correlation between alliance and outcome, and advocates of the above conflicting opinions used the same correlation to prove the validity of their position. Over the last few years, however, a revolution has taken place in alliance research, which brings this theoretical debate into the realm of the empirical. Several recent alliance studies have applied advanced methodologies to achieve this aim. Based on an integration of these studies, the present article proposes a new model for understanding the potential therapeutic role of alliance as sufficient to induce change by itself. The model stresses the importance of differentiating between patients' general tendencies to form satisfying relationships with others, which affect also the relationship with the therapist ("trait-like" component of alliance), and the process of the development of changes in such tendencies through interaction with the therapist ("state-like" component of alliance). The former enables treatment to be effective; the latter makes alliance therapeutic. Based on the literature, this article attempts to determine which of these components is the predictor of treatment outcome.
Incorporation of equine into mental health treatment continues to gain increased attention globally; however, there is a paucity of data quantifying behavioral interactions between humans and horses ...during these sessions. Therefore, the objective of this study was to quantify horse and human interactions during group psychotherapy sessions incorporating equine. Five college-aged women with anxiety took part in 7 weekly 90-min group psychotherapy sessions incorporating equine at a university. The group was facilitated by a licensed mental health counselor and equine specialist, with the same 3 equine partners throughout the 7 weeks. Sessions were videotaped and 4 of the sessions randomly selected for behavior coding. Ethograms of mutually exclusive human and horse behaviors were created and broadly categorized into non-aggressive interactions, aggressive interactions, and non-interaction behaviors. Thirty-second scan sampling was used to record behaviors by one trained observer throughout thestudy for a total of 640 time points. Behavior observations began when humans entered the arena and stopped when they exited. Means percentages of non-aggressive interactions and non-interactions were evaluated via t-test with differences set at P < 0.05. Humans and horses spent significantly more time (P = 0.01) engaged in non-interaction (58%) than in non-aggressive interaction behaviors (42%). No aggressive interactions were recorded. The most frequently observed interaction was “standing interaction” (i.e., horse or human standing within arm's reach of a human or horse, respectively). Further work is needed to identify the optimal quantity of horse and human interactions during psychotherapy sessions. Additionally, elucidating the role of these interactions in the treatment process is essential to support the practice of incorporating equine into mental health services.
Objective: The goal of this investigation was to examine the predictive validity of Client Emotional Productivity (CEP), an operationalization of optimal client in-session emotional processing, ...possessing seven features: Attending, symbolization, congruence, acceptance, regulation, agency and differentiation. Method: CEP was related to improvement in depressive and general symptoms, in 74 clients (66% female, 34% male) who received experiential therapy of depression and this was compared to the relationship between client high expressed emotional (CHEEA) arousal and the working alliance (WAI) and outcome. Results: Hierarchical regression analyses revealed that working phase CEP predicted significant reduction of depressive and general symptoms over and above that predicted by beginning phase CEP, the working alliance and working phase CHEEA. Working phase CEP emerged as the sole, independent predictor of outcome for both depressive and general symptoms. Conclusion: Productive emotional processing, thus, mediates the relationship between the alliance and outcome and seems to go beyond mere activation and expression of emotional experience. It rather seems to involve an increase in the ability to process activated primary emotion in a productive manner specified by CEP.
Summary This review links practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. We studied practice by reviewing reports of mental ...health and psychosocial support activities (2007–10); funding by analysis of the financial tracking service and the creditor reporting system (2007–09); and interventions by systematic review and meta-analysis. In 160 reports, the five most commonly reported activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%). Most interventions took place and were funded outside national mental health and protection systems. 32 controlled studies of interventions were identified, 13 of which were randomised controlled trials (RCTs) that met the criteria for meta-analysis. Two studies showed promising effects for strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis, because its definition varied across studies. In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed beneficial effects for several interventions (psychotherapy and psychosocial supports) compared with usual care or waiting list (standardised mean difference SMD −0·38, 95% CI −0·55 to −0·20). In children, meta-analysis of four RCTs failed to show an effect for symptoms of PTSD (–0·36, −0·83 to 0·10), but showed a beneficial effect of interventions (group psychotherapy, school-based support, and other psychosocial support) for internalising symptoms (six RCTs; SMD −0·24, −0·40 to −0·09). Overall, research and evidence focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little rigorous scrutiny.
Psychological treatments for perinatal depression Stuart, Scott, MD; Koleva, Hristina, MD
Best practice & research. Clinical obstetrics & gynaecology,
01/2014, Letnik:
28, Številka:
1
Journal Article
Recenzirano
Perinatal depression is prevalent and greatly affects the mother and infant. Fortunately, empirically validated psychological treatments are available for postpartum depression and depression during ...pregnancy. Primary among these are interpersonal psychotherapy and cognitive–behavioural therapy, which have been shown to be effective for perinatal women across the spectrum from mild to severe depression. At present, interpersonal psychotherapy is better validated than antidepressant medication for perinatal depression, and should be considered as a first-line treatment option, especially for pregnant and breast-feeding women who are depressed. More studies are needed to evaluate further the relative efficacy of psychotherapy and medication, and more thoroughly test other psychological treatments.
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