Clinical significance: A statistical appraoch to defining meaningful change in psychotherapy research

Understanding "patient deterioration" in psychotherapy from depressed patients' perspectives: A mixed methods multiple case study

Article

Full-text available

Feb 2024
PSYCHOTHER RES

Evaluating the Effectiveness of Take it Personal!+ in People With Mild Intellectual Disability or Borderline Intellectual Functioning and Substance Use Disorder: A Multiple Baseline Single-Case Experimental Study

Article

Full-text available

Jul 2023
BEHAV THER

Benefits of the Growing up Together Online Parenting Program for Families in Social Services in Croatia

Article

Full-text available

Jan 2024
J Child Fam Stud

Parenting programs have the ability to enhance parenting quality and healthy child development, but the overwhelming majority of evidence for their effects comes from a small minority of countries and research-intensive contexts. More evidence is needed from effectiveness studies (rather than highly controlled efficacy studies) and from countries less well-represented in the international literature. We examined changes in parental cognitions and parenting behavior in 62 families completing a 10-week online group program (Growing up Together Online) as part of social services in Croatia in 2020 and 2021, during the Covid-19 pandemic and earthquake. Parents reported on their cognitions and behaviors before and after the intervention. Paired-sample t-tests show significant improvements in parent-reported general self-esteem, parenting self-efficacy, and parenting experience and morale. Parents also reported significant reductions in angry, harsh, and violent parenting. Parents did not report increased attempts to understand children’s perspectives and positive interactions (e.g. joint play). Reliable change index analysis showed that reliable improvement was most common in parenting self-efficacy and least common in positive involvement and reinforcement. Findings provide preliminary evidence for the program’s potential to optimize the parenting conditions of children growing up in an environment at risk for child abuse and neglect.

A Pilot Study of a Cognitive-Behavioral Sleep Intervention Specifically for Adolescents With ADHD and Sleep Problems: A Qualitative and Quantitative Evaluation

Article

Dec 2023
COGN BEHAV PRACT

Enhancing Accessibility and Scalability of School-Based Programs to Improve Youth Attention and Behavior: Open Feasibility Trial of the Remote CLS-R-FUERTE Program in Mexico

Article

Full-text available

Nov 2023

Neurodevelopmental disorders of inattention and disruptive behavior, such as attention-deficit/hyperactivity disorder and oppositional defiant disorder, are among the most common youth mental health conditions across cultures. There is a need to develop more accessible school-based intervention and training programs, as well as create a system with clinical research capacity for scalable school clinician training and evaluation, to support students with attention and behavior concerns worldwide. We adapted the collaborative life skills program for Mexico (i.e., CLS-FUERTE) for remote delivery (i.e., CLS-R-FUERTE) and conducted a three-school open trial with N = 67 participants (n = 7–8 students per school [ages 6–12] and their parents, teachers, and school clinicians). We examined fidelity to program content, attendance and adherence records, in vivo observations of program delivery, and postmeeting feedback informing iterative program changes between each school cohort. We also examined improvements in youth attention and behavior rated by parents and teachers to evaluate the remote program effectiveness. CLS-R-FUERTE feasibility, acceptability, and usability findings were promising. Iterative program changes between each school cohort were minor and included adapted curriculum order, enhanced engagement strategies, and technology adjustments. Many students demonstrated reliable change, and the pre–post program improvements were comparable to outcomes from the in-person CLS-FUERTE trial, indicating preliminary effectiveness. Our pilot CLS-R-FUERTE effort supports the process of iteratively adapting, implementing, and evaluating remote school-based intervention and training programs to enhance potential flexibility, accessibility, and scalability. Challenges emerging from technological problems and in context of the COVID-19 pandemic, as well as solutions, are discussed.

INTERVENTION PROGRAM WITH THE CLOZE TECHNIQUE: ELABORATION AND CLINICAL SIGNIFICANCE

Article

Full-text available

Oct 2023

The hypothesis of this study is based on the fact that a remediation program with the Cloze Technique, leveled by different degrees of difficulties, it can contribute to the development of reading comprehension of students with reading comprehension difficulties. Therefore, the objective was to develop this program and analyze the clinical significance. For this, an intervention program was developed through a bibliographic review and after that a pilot study was carried out and applied in 28 elementary school students, divided into Group I Experimental (students with difficulty in narrative text submitted to the intervention); Group I Control (students with difficulty in narrative text not submitted to the intervention); Group II Experimental (students with difficulty in expository text submitted to the intervention); Group II Control (students with difficulty in expository text not submitted to the intervention). The results analyzed by the JT Method showed a reliable positive change with clinical significance for students in Group I Study, and significantly for students in Group II Experimental. Keywords: reading; reading comprehension; cloze test; reading remediation

Comparing written exposure therapy delivered via telehealth to trauma‐focused expressive writing in undergraduates: A proof‐of‐concept trial

Article

Oct 2023

The literature demonstrates that posttraumatic stress disorder (PTSD) rates are estimated to be higher on college campuses compared to lifetime estimates in the general population. Written exposure therapy (WET) is a promising brief intervention for posttraumatic stress symptoms (PTSS) with a growing literature of evidence suggesting efficacy, lower drop‐out rates compared to other evidence‐based protocols, and long‐term treatment gains. This proof‐of‐concept study examined the efficacy of WET delivered via telehealth compared to expressive writing (EW), the protocol from which WET was derived. The sample included non–treatment‐seeking trauma‐exposed undergraduate students ( N = 33) with elevated PTSS. The results suggest that both WET, g = 1.26, and EW, g = 0.61, were associated with within‐person decreases in PTSS. However, reliable change indices indicated that a significantly larger proportion of individuals in the WET condition (61.5%) demonstrated reliable symptom improvement compared to those who received EW (20.0%), g = 0.91. Contrary to our hypotheses, the WET and EW groups did not differ on reliable slopes of change; however, between‐group effects were underpowered and should be interpreted with caution. These findings offer preliminary support for WET delivered via telehealth, including for individuals with subthreshold PTSS.

How does change occur in psychotherapy? Innovative moments predict stronger therapeutic alliance and functional improvement in a psychodynamic case study

Article

Oct 2023

ABSTRACT Innovative moments (IMs) in psychotherapy contradict or challenge clients’ maladaptive patterns of meaning associated with their suffering. IMs are receiving increased theoretical and empirical attention in psychotherapy research and are associated with symptomatic improvement. However, little is known about possible predictors of IMs and their impact beyond their association with outcomes. A therapeutic alliance (TA) that implies a collaborative bond between clients and therapists might set the stage for the occurrence of IMs. Additionally, the occurrence of IMs could serve as a relational experience within the session that strengthens the TA. Thus, in the present study, we examined the association over time between IMs and (i) TA, and (ii) functioning, in a time-limited case study with a good outcome. Furthermore, this study is one of the first to explore IMs in psychodynamic therapy (PDT). Transcriptions of ten randomly selected sessions of PDT of a 43-year-old male with dysthymia were coded using the innovative moment coding system. Self-report measures of function and TA were collected at each session. Data were analyzed using simulation modeling analysis. Consistent with good-outcome cases in other therapeutic approaches, high-level IMs (H-IMs) increased while low-level IMs (L-IMs) decreased throughout treatment. H-IMs predicted a change in functioning in the following session. Finally, H-IMs were associated with higher TA post-session, and specifically with agreement on treatment tasks. To conclude, moments of change in the client’s pattern of meaning are related to stronger TA and better treatment outcome. If replicated, these findings may provide important insights regarding the unfolding of therapeutic change.

How Can Social Workers Assess Clinically Meaningful Change in Their Clients? An Example from Children in Care

Article

Full-text available

Jul 2023
CLIN SOC WORK J

Social workers use interventions in the expectation that they will make a positive difference for their clients. However, research about the effectiveness of interventions is typically presented at the group level, which places great demands on social workers’ ability to apply such results to the needs of individual clients. Further, the content and effects of “service as usual” (SAU) interventions that social workers typically offer are often not known, making it difficult for social workers to identify what aspects of the intervention any client change can be attributed to. Using indicators of clinically meaningful change (CMC) strengthens social workers’ ability to identify what, if anything, works in any given intervention for their individual clients, and also motivates their curiosity to identify the efficacious components of SAU. CMC refers to changes in an individual’s outcome measures that are reliable or are large enough to be considered “important.” We present five indicators to analyze CMC in a child’s psychological well-being measured with the Strengths and Difficulties Questionnaire and illustrate their use with two empirical examples from the project Me and My Foster Family. The examples demonstrated that conclusions regarding CMC can vary depending on the indicator used, the baseline assessment, and the magnitude of raw-score change on the measured outcome. To assess change at the individual level it is important to address questions of measurement reliability and the yardstick for judging when a change is large enough to be considered “important.” Implications for research and practice are discussed.

Neural correlates of stress-reactive rumination in depression – The role of childhood trauma and social anxiety

Article

May 2024

Recent work showed an association of prefrontal dysfunctions in patients with Major Depressive Disorder (MDD) and social stress induced rumination. However, up to date it is unclear which etiological features of MDD might cause prefrontal dysfunctions. In the study at hand, we aimed to replicate recent findings, that showed prefrontal activation alterations during the Trier Social Stress Test (TSST) and subsequently increased stress-reactive rumination in MDD compared to healthy controls. Moreover, we aimed to explore the role of adverse childhood experiences and other clinical variables in this relationship. N = 55 patients currently suffering from MDD and n = 42 healthy controls (HC) underwent the TSST, while cortical activity in areas of the Cognitive Control Network (CCN) was measured via functional near-infrared spectroscopy (fNIRS). The TSST successfully induced a stress reaction (physiologically, as well as indicated by subjective stress ratings) and state rumination in all subjects with moderate to large effect sizes. In comparison to HC, MDD patients showed elevated levels of state rumination with large effect sizes, as well as a typical pattern of reduced cortical oxygenation during stress in the CCN with moderate effect sizes. Self-reported emotional abuse and social anxiety were moderately positively associated with increased stress-reactive rumination. Within the MDD sample, emotional abuse was negatively and social anxiety positively associated with cortical oxygenation within the CCN with moderate to large effect sizes. In conclusion, our results replicate previous findings on MDD-associated prefrontal hypoactivity during stress and extends the research toward specific subtypes of depression.

Efficacy Of Online Cognitive Behavioral Therapy For Social Anxiety Disorder Comorbid With Depression

Article

Full-text available

May 2024

To evaluate the effectiveness of online cognitive behavior therapy, treatment of a 20-year-old girl was executed through Skype over 9-months including 22 Psychotherapy sessions. According to DSM-5 she was diagnosed with "Social Anxiety Disorder, Performance Only" and "Major Depressive Disorder, Moderate". Pre-test assessment through Liebowitz Social Anxiety Scale, Brief Fear of Negative Evaluation Scale, Self-Statements during Public Speaking Scale, and Beck Depression Inventory indicated prominent social phobia, clinically significant social anxiety, frequent negative self-statements, and severe depression respectively. Cognitive behavioral techniques were applied including identifying cognitive distortions and cognitive restructuring, belief change through Socratic dialogues, systematic desensitization, problem solving, and developing communication skills. The post-treatment assessments showed no social phobia/ anxiety and depression and more positive self-statements while rare negative self-statements were found till 1-month follow-up that completely faded over 3-months, 6-months, 2.5 years, and 5 years follow-ups. To evaluate progress over time, separate client and clinician ratings were recorded in every session through Subjective Units of Distress Scale and Clinical Global Impressions Scale respectively. Before the start of treatment, client rating indicated a distress level near to freak-out and alienate which coincided with clinician rating showing markedly ill level with no change from baseline. Gradual reduction in distress and improvement was observed throughout treatment while both client and clinician rating at the end of treatment indicated a normal level, improved state, peace, serenity, and total relief suggesting no more anxiety of any kind. Further, the Credibility/Expectancy Questionnaire showed that at beginning client rated on average 85% credibility and positive expectancy of treatment outcomes which improved to 95% on average at the end of treatment. Overall, objective and subjective measures were found to demonstrate stable outcomes over 5 years suggesting that online cognitive behavioral therapy stands as effective treatment for social anxiety disorder and depression. The efficacious outcomes are especially significant in relevance to the pre and post covid technological advancements in the field of clinical psychology.

Satisfaction, engagement, and outcomes in internet-delivered cognitive behaviour therapy adapted for people of diverse ethnocultural groups: an observational trial with benchmarking

Article

Full-text available

Mar 2024

Introduction Depression and anxiety are the most common mental health disorders worldwide. Internet-Delivered Cognitive Behaviour Therapy (ICBT) can reduce barriers to care to broad cross sections of the population. However, People of Diverse Ethnocultural Backgrounds (PDEGs) other than White/Caucasian underutilize mental health services and are under represented in clinical trials of psychological interventions. Methods To address this research gap we adapted an evidence-based ICBT program for PDEGs. The current pilot study explores the engagement, satisfaction, and effectiveness in the adapted ICBT program by PDEGs (N=41) when benchmarked against a sample of PDEGs (N=134) who previously completed a non-adapted version of the ICBT program. Results An intent-to-treat analyses showed that the adapted ICBT program is effective in reducing anxiety and depression symptoms among PDEGs. Large within-group pre-to post-treatment Cohen’s effect sizes of d = 1.23, 95% CI [0.68, 1.77] and d = 1.24, 95% CI [0.69, 1.79] were found for depression and anxiety, respectively. Further, 81.8% of the PDEGs who received the adapted ICBT reported overall satisfaction, 90.9% reported increased confidence in managing symptoms, and 70.7% completed majority of the psychoeducational lessons in the ICBT program. Conclusion No statistically significant differences in the clinical outcomes, engagement, and satisfaction were found between the pilot study and benchmark sample. Future directions for ICBT research with PDEGs are described. Clinical trial registration https://beta.clinicaltrials.gov/study/NCT05523492, identifier NCT05523492.

Evaluation of an Online-Based Self-Help Program for Patients With Generalized Anxiety Disorder: A Randomized Controlled Trial

Article

Full-text available

Jan 2024

Objectives: This study aimed to evaluate the effects of an online self-help intervention for generalized anxiety disorder (GAD). Our primary outcomes were generalized anxiety symptoms, measured using the Generalized Anxiety Disorder – 7 (GAD-7; Spitzer et al., 2006), and wellbeing based on the World Health Organization Wellbeing Index - 5 (WHO-5; Topp et al., 2015). Methods: A total of 156 German-speaking patients aged 18 to 65 with a diagnosis of GAD and internet access were included in this randomized controlled trial. The intervention group (N = 78) received access to a 12-week online self-help program, while the waitlist control group (N = 78) received access after the 12-week waiting period. Results: The intervention group showed a significant improvement in generalized anxiety symptoms compared to the control group (t(df = 123.73) = 4.52, p < .001) with a large effect size (d = 0.88, 95 %-CI: 0.50; 1.26). Additionally, the intervention group demonstrated a significant increase in wellbeing compared to the control group (t(df = 87,86) = 3.48, p < .001), with a moderate effect size (d = 0.62, 95 % CI: 0.27; 0.98). However, no significant effects were observed for secondary outcomes of functional impairments, work productivity, mental health literacy, and healthcare demands. For exploratory outcomes, improvement was found for anxiety and worry symptoms. Conclusions: These findings suggest that an online-based self-help intervention effectively reduces GAD symptoms and improves overall wellbeing. Future research should explore the long-term effects of this intervention and investigate potential mechanisms underlying its efficacy.

Satisfaction in Mental Health Care: Examining Psychometric Properties of Experience of Service Questionnaire in a Turkish Population

Preprint

Full-text available

Jan 2024

Objective: Measuring satisfcation with psychological health services is important in clinical settings in order to evaluate the benefits of treatment. Past research has shown that relationship with clinician is at the core of satisfaction reports. However, measurement tools focusing on patients’ psyhcological health care experiences are rather scarce. The objective of this study is to adapt the Experience of Service Questionnaire (ESQ) Parent form and examine its psychometric properties in a Turkish population. Method: ESQ Parent form was translated into Turkish and was presented to parents (N = 242) of children who have completed their treatment in a university’s psychological counseling center. Child Behavior Checklist (CBCL) was also gathered from parents pre- and post-treatment in order to measure symptomatic gains and investigate their associations with satisfaction with treatment. Results: Factor analysis revealed a two-factor solution (‘Care’ and ‘Environment’) similar to questionnaire’s original structure. In addition, discriminant validity results showed that participants showing higher therapeutic gains (as measured by CBCL) show significantly higher satisfaction in ESQ. Conclusions: This study is the first to measure satisfaction in psychological health care settings in Turkey, and therefore aims to contribute to a gap in the field. Results indicate a significant association between treatment outcome and satisfaction levels. Also, adapted measurement tool demonstrates adquate reliability and validity scores supporting it’s use in clinical settings.

Predicting Effects of a Digital Stress Intervention for Patients With Depressive Symptoms: Development and Validation of Meta-Analytic Prognostic Models Using Individual Participant Data

Article

Full-text available

Dec 2023

Objective: Digital stress interventions could be helpful as an “indirect” treatment for depression, but it remains unclear for whom this is a viable option. In this study, we developed models predicting individualized benefits of a digital stress intervention on depressive symptoms at 6-month follow-up. Method: Data of N = 1,525 patients with depressive symptoms (Center for Epidemiological Studies’ Depression Scale, CES-D ≥ 16) from k = 6 randomized trials (digital stress intervention vs. waitlist) were collected. Prognostic models were developed using multilevel least absolute shrinkage and selection operator and boosting algorithms, and were validated using bootstrap bias correction and internal–external cross-validation. Subsequently, expected effects among those with and without a treatment recommendation were estimated based on clinically derived treatment assignment cut points. Results: Performances ranged from R² = 21.0%–23.4%, decreasing only slightly after model optimism correction (R² = 17.0%–19.6%). Predictions were greatly improved by including an interim assessment of depressive symptoms (optimism-corrected R² = 32.6%–35.6%). Using a minimally important difference of d = −0.24 as assignment cut point, approximately 84.6%–93.3% of patients are helped by this type of intervention, while the remaining 6.7%–15.4% would experience clinically negligible benefits (δ^ = −0.02 to −0.19). Using reliable change as cut point, a smaller subset (39.3%–46.2%) with substantial expected benefits (δ^ = −0.68) receives a treatment recommendation. Conclusions: Meta-analytic prognostic models applied to individual participant data can be used to predict differential benefits of a digital stress intervention as an indirect treatment for depression. While most patients seem to benefit, the developed models could be helpful as a screening tool to identify those for whom a more intensive depression treatment is needed.

Reliability and Validity of the Heel Rise Test Using the Mobile Application

Article

Full-text available

Nov 2023

Select or adjust? How information from early treatment stages boosts the prediction of non-response in internet-based depression treatment

Article

Full-text available

Dec 2023
PSYCHOL MED

Background Internet-based interventions produce comparable effectiveness rates as face-to-face therapy in treating depression. Still, more than half of patients do not respond to treatment. Machine learning (ML) methods could help to overcome these low response rates by predicting therapy outcomes on an individual level and tailoring treatment accordingly. Few studies implemented ML algorithms in internet-based depression treatment using baseline self-report data, but differing results hinder inferences on clinical practicability. This work compares algorithms using features gathered at baseline or early in treatment in their capability to predict non-response to a 6-week online program targeting depression. Methods Our training and test sample encompassed 1270 and 318 individuals, respectively. We trained random forest algorithms on self-report and process features gathered at baseline and after 2 weeks of treatment. Non-responders were defined as participants not fulfilling the criteria for reliable and clinically significant change on PHQ-9 post-treatment. Our benchmark models were logistic regressions trained on baseline PHQ-9 sum or PHQ-9 early change, using 100 iterations of randomly sampled 80/20 train-test-splits. Results Best performances were reached by our models involving early treatment characteristics (recall: 0.75–0.76; AUC: 0.71–0.77). Therapeutic alliance and early symptom change constituted the most important predictors. Models trained on baseline data were not significantly better than our benchmark. Conclusions Fair accuracies were only attainable by involving information from early treatment stages. In-treatment adaptation, instead of a priori selection, might constitute a more feasible approach for improving response when relying on easily accessible self-report features. Implementation trials are needed to determine clinical usefulness.

Islamic trauma healing (ITH): A scalable, community-based program for trauma: Cluster randomized control trial design and method

Article

Full-text available

Dec 2023

Background Somalia has long been in a state of humanitarian crisis; trauma-related mental health needs are extremely high. Access to state-of-the-art mental health care is limited. Islamic Trauma Healing (ITH) is a manualized mosque-based, lay-led group intervention aimed at healing the individual and communal mental wounds of war and refugee trauma. The 6-session intervention combines Islamic principles with empirically-supported exposure and cognitive restructuring principles for posttraumatic stress disorder (PTSD). ITH reduces training time, uses a train the trainers (TTT) model, and relies on local partnerships embedded within the strong communal mosque infrastructure. Methods We will conduct a hybrid effectiveness-implementation randomized control trial (RCT) in the Somaliland, with implementation in the cities of Hargeisa, Borama, and Burao. In this study, a lay-led, mosque-based intervention, Islamic Trauma Healing (ITH), to promote mental health and reconciliation will be examined in 200 participants, randomizing mosques to either immediate ITH or a delayed (waitlist; WL) ITH conditions. Participants will be assessed by assessors masked to condition at pre, 3 weeks, 6 weeks, and 3-month follow-up. Primary outcome will be assessor-rated posttraumatic stress symptoms (PTSD), with secondary outcomes of depression, somatic symptoms, and well-being. A TTT model will be tested, examining the implementation outcomes. Additional measures include potential mechanisms of change and cost effectiveness. Conclusion This trial has the potential to provide effectiveness and implementation data for an empirically-based principle trauma healing program for the larger Islamic community who may not seek mental health care or does not have access to such care. Clinical trial registration number ClinicalTrials.gov NCT05890482. World health organization trial registration data set information See Supplemental Appendix 1.

Dynamic and static predictive modelling of psychotherapy outcome-Comparison of two statistical approaches

Article

Dec 2023
CLIN PSYCHOL PSYCHOT

Objective: Improving prediction abilities in the therapy process can increase therapeutic success for a variety of reasons, such as more personalised treatment or resource optimisation. The increasingly applied methods of dynamic prediction seem to be very promising for this purpose. Prediction models are usually based on static approaches of frequentist statistics. However, the application of this statistical approach has been widely criticised in this research area. Bayesian statistics has been proposed in the literature as an alternative, especially for the task of dynamic modelling. In this study, we compare the performance of predicting therapy outcome over the course of therapy between both statistical approaches. Method: Based on a sample of 341 patients, a logistic regression analysis was performed using both statistical approaches. Therapy success was conceptualised as reliable pre-post improvement in brief symptom inventory (BSI) scores. As predictors, we used the subscales of the Outcome Questionnaire (OQ-30) and the Helping Alliance Questionnaire (HAQ) measured every fifth session, as well as baseline BSI scores. Results: The influence of the predictors during therapy differs between the frequentist and the Bayesian approach. In contrast, predictive validity is comparable with a mean area under the curve (AUC) of 0.76 in both model types. Conclusion: Bayesian statistic provides an innovative and useful alternative to the frequentist approach in predicting therapy outcome. The theoretical foundation is particularly well suited for dynamic prediction. Nevertheless, no differences in predictive validity were found in this study. More complex methodology as well as further research seems necessary to exploit the potential of Bayesian statistics in this area.

Who Declines and Who Improves in Wilderness Therapy?

Article

Full-text available

Nov 2023
Child Youth Care Forum

Background Extensive research into wilderness therapy has not explored who benefits the most and who does not thrive in these programs. Objective The present study examined demographic, clinical, and familial characteristics that distinguished adolescents who improve most in wilderness therapy programs from those who deteriorate. Method Using data collected by the National Association of Therapeutic Schools and Programs Practice Research Network, the study sample consisted of 5639 adolescents attending wilderness therapy programs which collected and contributed data to the Practice Research Network between 2017 and 2022. Measures included the Youth Outcome Questionnaire-Self Report and the McMaster Family Assessment Device, as well as demographic, familial, and clinical data collected by program staff. Results Using binary and univariate logistic regression, the study found individual and familial factors that predicted membership in the top 10% of adolescent participants in terms of mental health improvement from pre-to-post wilderness therapy and those factors which predicted membership in the bottom 10% in terms of poorer mental health from pre-to-post program. Conclusions Considering the intensity, length, and financial resources associated with wilderness therapy program participation, these findings have important implications for wilderness therapy program staff professional development, communication of expectations to adolescents’ parents/caregivers, and program admission decisions.

The effectiveness, efficiency, and acceptability of EMDR vs. EMDR 2.0 vs. the Flash technique in the treatment of patients with PTSD: study protocol for the ENHANCE randomized controlled trial

Article

Full-text available

Nov 2023

Background Several widely studied therapies have proven to be effective in the treatment of post-traumatic stress disorder (PTSD). However, there is still room for improvement because not all patients benefit from trauma-focused treatments. Improvements in the treatment of PTSD can be achieved by investigating ways to enhance existing therapies, such as eye movement desensitization and reprocessing (EMDR) therapy, as well as exploring novel treatments. The purpose of the current study is to determine the differential effectiveness, efficiency, and acceptability of EMDR therapy, an adaptation of EMDR therapy, referred to as EMDR 2.0, and a novel intervention for PTSD, the so-called Flash technique. The second aim is to identify the moderators of effectiveness for these interventions. This study will be conducted among individuals diagnosed with PTSD using a randomized controlled trial design. Methods A total of 130 patients diagnosed with (complex) PTSD will be randomly allocated to either six sessions of EMDR therapy, EMDR 2.0, or the Flash technique. The primary outcomes used to determine treatment effectiveness include the presence of a PTSD diagnosis and the severity of PTSD symptoms. The secondary outcomes of effectiveness include symptoms of depression, symptoms of dissociation, general psychiatric symptoms, and experiential avoidance. All patients will be assessed at baseline, at 4-week post-treatment, and at 12-week follow-up. Questionnaires indexing symptoms of PTSD, depression, general psychopathology, and experiential avoidance will also be assessed weekly during treatment and bi-weekly after treatment, until the 12-week follow-up. Efficiency will be assessed by investigating the time it takes both to lose the diagnostic status of PTSD, and to achieve reliable change in PTSD symptoms. Treatment acceptability will be assessed after the first treatment session and after treatment termination. Discussion This study is the first to investigate EMDR 2.0 therapy and the Flash technique in a sample of participants officially diagnosed with PTSD using a randomized controlled trial design. This study is expected to improve the available treatment options for PTSD and provide therapists with alternative ways to choose a therapy beyond its effectiveness by considering moderators, efficiency, and acceptability. Trial registration The trial was retrospectively registered in the ISRCTN registry at 10th November 2022 under registration number ISRCTN13100019.

PROGRAMA DE INTERVENÇÃO COM A TÉCNICA DE CLOZE: ELABORAÇÃO E SIGNIFICÂNCIA CLÍNICA

Article

Full-text available

Oct 2023

The hypothesis of this study is based on the fact that a remediation program with the Cloze Technique, leveled by different degrees of difficulties, it can contribute to the development of reading comprehension of students with reading comprehension difficulties. Therefore, the objective was to develop this program and analyze the clinical significance. For this, an intervention program was developed through a bibliographic review and after that a pilot study was carried out and applied in 28 elementary school students, divided into Group I Experimental (students with difficulty in narrative text submitted to the intervention); Group I Control (students with difficulty in narrative text not submitted to the intervention); Group II Experimental (students with difficulty in expository text submitted to the intervention); Group II Control (students with difficulty in expository text not submitted to the intervention). The results analyzed by the JT Method showed a reliable positive change with clinical significance for students in Group I Study, and significantly for students in Group II Experimental. Keywords: reading; reading comprehension; cloze test; reading remediation

Terapia de aceptación y compromiso con familiares de hijos/as con discapacidad intelectual: un estudio piloto

Article

Full-text available

Sep 2023

Resumen Terapia de aceptación y compromiso con familiares de hijos/as con discapacidad intelectual: un estudio piloto El objetivo del estudio es la valoración de los resultados de un programa de intervención grupal desde la Terapia de Aceptación y Compromiso dirigido a familiares de hijos/as con diagnóstico de discapacidad intelectual ligera. En el estudio participaron cuatro madres y un padre pertenecientes a una asociación de discapacidad. Para valorar la efectividad del entrenamiento se emplearon autoinformes para medir flexibilidad parental, supresión de pensamientos, estrés percibido y salud psicológica, así como autorregistros para medir los cambios en las interacciones con los hijos/as. Los resultados mostraron que tras el entrenamiento y en el seguimiento, a los 2 meses se incrementó significativamente la flexibilidad psicológica y disminuyó la supresión de pensamientos negativos. El tamaño del efecto fue elevado, además de en estas variables, en estrés percibido y salud psicológica. Además, se observó un incremento de interacciones placenteras con los hijos/as con discapacidad. El estudio reveló la potencial utilidad de esta intervención y justificó y aportó claves relevantes para un estudio posterior con una muestra más amplia. Entendemos que con el desarrollo del programa de intervención podríamos poner en manos de los profesionales de la orientación y de las familias un instrumento con la capacidad de mejorar la calidad de vida de las personas con discapacidad, y de sus familiares. Palabras clave: parentalidad, flexibilidad psicológica, discapacidad, terapias contextuales, terapia de aceptación y compromiso, ACT, estrés parental. Abstract Acceptance and commitment therapy for family members of children with intellectual disabilities: a pilot study The aim of the study was to assess the results of a group intervention program grounded in Acceptance and Commitment Therapy. The intervention was delivered to relatives of children with a diagnosis of intellectual disability. Four mothers and one father from a disability association participated in the study. Effectiveness was

Emotion dynamics of clients with test anxiety before and after an imagery-based treatment

Article

Sep 2023
J BEHAV THER EXP PSY

Background and objectives: Imagery-based techniques have become a promising means in the treatment of test anxiety (TA). Although previous studies have demonstrated the effectiveness of imagery-based treatment, not all clients seem to benefit from it. The present study compares clients’ pre- as well as post-treatment emotion dynamics between responders and non-responders. Furthermore, it examines treatment-related changes in emotion dynamics in both subgroups. Methods: The results are based on 44 clients suffering from TA who underwent a six-session imagery-based treatment and include Ecological Momentary Assessment (EMA). Emotions were assessed with the Profile of Mood States four times a day over the course of two weeks before and after the treatment. Temporal networks were computed to index emotion dynamics. Results: Pre-treatment emotion dynamics differed between responders and non-responders. Similarly, posttreatment emotion dynamics differed as well between both groups. Some changes were also observed between pre-treatment and post-treatment networks: for responders, fatigue no longer predicted anger, and depression predicted itself; for non-responders, calmness predicted fatigue, anger, depression, contentment, and anxiety. In addition, fatigue no longer predicted itself and anxiety predicted vigor. Limitations: The investigation is marked by several limitations: a liberal inclusion threshold of at least a 50% response to EMA prompts, and a relatively homogenous sample. Conclusion: These results provide first evidence for the idea that emotion dynamics may be associated with response to treatment for TA. Furthermore, effective imagery-based treatments may be tied to changes within these dynamics.

Effects of Borderline Personality Disorder Symptoms on Dialectical Behavior Therapy Outcomes for Eating Disorders

Article

Full-text available

Aug 2023

Existing literature on the effects of borderline personality disorder (BPD) and eating disorder (ED) comorbidity in terms of clinical presentation and treatment outcome has been limited and inconclusive. The present study examined whether clients with EDs and varying levels of BPD symptoms presented with more severe ED symptoms at admission, and whether they responded to dialectical behavior therapy (DBT)-based treatment. Participants (N = 176) were adults in a DBT-based partial hospitalization program for EDs at an academic medical center. Participants completed self-report measures at admission, 1-month postadmission, discharge, and 6-month follow-up. Results suggested that patients with elevated BPD symptoms at admission had greater ED symptoms during treatment, evidenced by small to moderate effect sizes. However, patients with high BPD symptoms demonstrated steeper declines in binge eating, fasting, and parasuicidal behavior early during treatment compared to patients with low BPD symptoms. Individuals with high BPD symptoms at admission (i.e., probable BPD diagnosis) were as likely to meet remission criteria and relapse as individuals with low BPD symptoms, though this null finding may be influenced by small cell sizes. Our findings also suggest that DBT skills use does not predict changes in symptoms. In sum, our findings suggest that while clients with higher BPD symptoms may improve during DBT-based partial hospitalization, their ED symptoms may remain more severe. Future studies are needed to determine whether adjunctive treatments improve outcomes for clients with EDs and comorbid BPD symptoms in DBT programs and whether skills use quality is a better predictor of ED symptom changes.

Understanding Sexual Aggression in UK Male University Students: An Empirical Assessment of Risk Factors and Online Harm Prevention Programming

Thesis

Full-text available

Oct 2022

Samuel T. Hales

University-based sexual aggression is a pervasive public health issue associated with numerous negative, long-term outcomes. Most scientific literature on the topic has emanated from the US, where researchers possess a solid academic understanding of sexual aggression by male university students - the leading perpetrators of campus-based sexual offences - and have evaluated various harm prevention strategies for tackling the issue. This contrasts with the UK, where academic assessments of male students' illegal sexual behaviours are scant and research evaluating evidence-based prevention interventions is embryonic. This is despite established high rates of sexual victimisation across campuses nationally. To help catalyse research into university-based sexual aggression in the UK, this thesis presents six novel empirical studies that offer some of the first psychological insights into UK male students' sexual offending behaviours. These include studies assessing the prevalence of, and socio-ecological risk factors associated with, the harmful sexual behaviours of male university students in the UK, the heterogeneity of self-reported perpetrators as a group of forensic interest, and the efficacy of evidence-based online harm prevention programming at reducing UK university males' sexual offence proclivity. Considered together, findings suggest that (a) UK male students are at increased risk of sexual perpetration at university; (b) perpetrators' behaviours are guided by various socio-ecological risk factors, which differentiate them from their non-offending peers; (c) students with harmful sexual histories comprise a heterogeneous forensic group who can be meaningfully categorised based on their psychological characteristics; and (d) evidence-based online harm prevention programming can effectively reduce the short and longer-term risk of sexual offending amongst UK university males. The implications of findings for academic research and UK harm prevention work are discussed, alongside methodological limitations.

Evaluation of an Online-Based Self-Help Program for Patients with Panic Disorder: A Randomized Controlled Trial

Preprint

Full-text available

Jul 2023

Objectives: The present study evaluated the effectiveness of a minimally-guided online self-help intervention for panic disorder with or without agoraphobia. As our primary hypotheses, we expected the intervention to improve both panic symptoms and well-being. Methods: German-speaking patients (N = 156) between 18 and 65 with internet access and a diagnosis of panic disorder or agoraphobia with panic disorder were recruited for this randomized controlled trial. The intervention group (N = 84) received access to a 12-week online self-help program. The waitlist control group (N = 72) received no intervention during the study period but was offered the prospect of using the program after 12 weeks. Results: Changes in PAS revealed a significant effect in favor of the intervention group (t (df = 110.1) =-2.22, padj = .027) with a small to moderate effect size (d =-0.37, 95%-CI:-0.70;-0.04). No significant effect was found for the second primary outcome WHO-5 (t (df = 149.8) = 1.35, padj = .088) or the secondary outcomes functioning, mental health literacy, working ability and healthcare use). Conclusions: The presented online intervention can help reduce the core symptomatology of panic disorder with or without agoraphobia. Diminished effects may be due to higher illness burden in the intervention group and possibly the COVID pandemic which caused unique challenges to patients suffering from panic disorder. Regarding well-being and the secondary outcomes, superiority towards the control group was not established. Therefore, further research and intervention adaptations may be warranted to improve these outcomes. Public health implications: Web-based self-help interventions can decrease the symptom burden for patients with panic disorder with or without agoraphobia. These findings provide the basis for implementing the intervention into routine clinical care.

Assessing Implicit Theories in Sexual Offending Using Indirect Measures: Feasibility, Reliability, and Incremental Validity

Article

May 2024

This study assessed psychometric qualities of indirect measures assessing Implicit Theories (ITs) of sexual offending: Implicit Association Task (IAT), Implicit Relational Assessment Procedure (IRAP), and Relational Responding Task (RRT). For comparison reasons, aggressive behavior was also assessed. In a male sample from the general population ( N = 109), we assessed each measure’s (a) feasibility (mean latency, error rate, passing criteria), (b) internal consistency, (c) convergent and discriminant validity, and (d) incremental and predictive validity. Results indicated that no indirect measure met all criteria. Although the IAT was reasonably feasible and reliable in measuring aggression, ITs could not be reliably assessed. The RRT was feasible and somewhat reliable in assessing ITs, whereas the IRAP showed limited feasibility, high task complexity, low reliability, and the presence of a method factor. No measure had incremental predictive validity over the use of self-report measures, although we note that the power to detect such associations was limited. As none of the indirect measures performed satisfactorily on the measured criteria, the use of these measures in clinical practice seems currently unwarranted to assess ITs.

EFFects of Exposure and Cognitive behavioral Therapy for chronic BACK pain (“EFFECT-BACK”): study protocol for a randomized controlled trial

Article

Full-text available

Mar 2024
TRIALS

Introduction Chronic back pain is a widespread medical condition associated with high socioeconomic costs and increasing prevalence. Despite the advanced implementation of multidisciplinary approaches, providing a satisfactory treatment offer for those affected is often not possible. Exposure therapy (EXP) promises to be an effective and economical form of treatment and in a previous pilot study showed to be superior to cognitive behavioral therapy (CBT) in reducing perceived limitations of movement. The current study aims to further compare the efficacy of both treatment methods and identify those patient groups that particularly benefit from EXP. Methods The general objective of this randomized multicenter clinical trial (targeted N = 380) is to improve and expand the range of treatments available to patients with chronic back pain. As the primary objective of the study, two different psychological treatments (EXP and CBT) will be compared. The primary outcome measure is a clinically significant improvement in pain-related impairment, measured by the QPBDS, from baseline to 6-month follow-up. Secondary outcome measures are absolute changes and clinically significant improvements in variables coping, psychological flexibility, depressiveness, catastrophizing, exercise avoidance and fear of exercise, and intensity of pain. Participants are recruited in five psychological and medical centers in Germany and receive ten sessions of manualized therapy by trained licensed CBT therapists or clinical psychologists, who are currently in their post-gradual CBT training. Potential predictors of each treatment’s efficacy will be explored with a focus on avoidance and coping behavior. Conclusion This study will be the first RCT to compare CBT and EXP in chronic back pain in a large sample, including patients from different care structures due to psychological and medical recruitment centers. By identifying and exploring potential predictors of symptom improvement in each treatment group, this study will contribute to enable a more individualized assignment to treatment modalities and thus improves the care situation for chronic back pain and helps to create a customized treatment program for subgroups of pain patients. If our findings confirm EXP to be an efficacious and efficient treatment concept, it should gain more attention and be further disseminated. Trial registration ClinicalTrials.gov NCT05294081. Registered on 02 March 2022.

Conversational AI facilitates mental health assessments and is associated with improved recovery rates

Article

Mar 2024

Mental health services across the globe are overburdened due to increased patient need for psychological therapies and a shortage of qualified mental health practitioners. This is unlikely to change in the short-to-medium term. Digital support is urgently needed to facilitate access to mental healthcare while creating efficiencies in service delivery. In this paper, we evaluate the use of a conversational artificial intelligence (AI) solution ( Limbic Access ) to assist both patients and mental health practitioners with referral, triage, and clinical assessment of mild-to-moderate adult mental illness. Assessing this solution in the context of England’s National Health Service (NHS) Talking Therapies services, we demonstrate in a cohort study design that deploying such an AI solution is associated with improved recovery rates. We find that those NHS Talking Therapies services that introduced the conversational AI solution improved their recovery rates, while comparable NHS Talking Therapies services across the country reported deteriorating recovery rates during the same time period. Further, we provide an economic analysis indicating that the usage of this AI solution can be highly cost-effective relative to other methods of improving recovery rates. Together, these results highlight the potential of AI solutions to support mental health services in the delivery of quality care in the context of worsening workforce supply and system overburdening. For transparency, the authors of this paper declare our conflict of interest as employees and shareholders of Limbic Access, the AI solution referred to in this paper.

An Evaluation of Child and Parent Outcomes Following Community-Based Early Intervention with Randomised Parent-Mediated Intervention for Autistic Pre-Schoolers

Article

Full-text available

Feb 2024
Child Youth Care Forum

Background As autistic children are being diagnosed at a younger age, the need to identify appropriate early supports has increased. Therapist-delivered and parent-mediated autism intervention may benefit children and parents. Objective This pilot study examined developmental outcomes for autistic pre-schoolers and mental health and wellbeing outcomes for their parents (n = 53) following a 10-month intervention period. Methods All families were accessing therapist-delivered interventions—the Early Start Denver Model (ESDM) or usual community services—and some families also received additional parent-coaching ESDM (P-ESDM). Families were assessed at 3 timepoints. Results Overall children made significant gains in cognitive skills and adaptive behaviour, with no differences between groups. Parents overall reported increased parenting stress over time. P-ESDM conferred no added benefit for child outcomes, and similarly, no clear benefit for parent outcomes. Conclusions Our findings suggest that children receiving early intervention make developmental gains, regardless of type of intervention, and challenges assumptions that, as an adjunct to other intervention programs, P-ESDM improves child or parent outcomes. Further research is needed to explore the effects of parent-mediated programs.

Are web-based stress management interventions effective as an indirect treatment for depression? An individual participant data meta-analysis of six randomised trials

Article

Full-text available

Feb 2024

Question Depression is highly prevalent and associated with numerous adverse consequences for both individuals and society. Due to low uptake of direct treatment, interventions that target related, but less stigmatising problems, such as perceived stress, have emerged as a new research paradigm.This individual participant data (IPD) meta-analysis examines if a web-based stress management intervention can be used as an ‘indirect’ treatment of depression. Study selection and analysis Bayesian one-stage models were used to estimate pooled effects on depressive symptom severity, minimally important improvement and reliable deterioration. The dose–response relationship was examined using multilevel additive models, and IPD network meta-analysis was employed to estimate the effect of guidance. Findings In total, N=1235 patients suffering from clinical-level depression from K=6 randomised trials were included. Moderate-to-large effects were found on depressive symptom severity at 7 weeks post-intervention (d=−0.65; 95% credibility interval (CrI): −0.84 to −0.48) as measured with the Center for Epidemiological Studies’ Depression Scale. Effects were sustained at 3-month follow-up (d=−0.74; 95% CrI: −1.01 to −0.48). Post-intervention symptom severity was linearly related to the number of completed sessions. The incremental impact of guidance was estimated at d=−0.25 (95% CrI: −1.30 to 0.82), with a 35% posterior probability that guided and unguided formats produce equivalent effects. Conclusions Our results indicate that web-based stress management can serve as an indirect treatment, yielding effects comparable with direct interventions for depression. Further research is needed to determine if such formats can indeed increase the utilisation of evidence-based treatment, and to corroborate the favourable effects for human guidance. Study registration Open material repository: osf.io/dbjc8, osf.io/3qtbe. Trial registration number German Clinical Trial Registration (DRKS): DRKS00004749, DRKS00005112, DRKS00005384, DRKS00005687, DRKS00005699, DRKS00005990.

Treatment for Anxiety, Depression, and Family Conflict in Adolescence via Telehealth during the COVID-19 Pandemic

Article

Feb 2024
Clin Case Stud

Anxiety and depression are two of the most common mental health disorders diagnosed in adolescents. While either disorder individually creates impairments in psychological, emotional, and social functioning, these disorders often co-occur and reciprocally influence one another which can lead to continual worsening in functioning over time. Specifically with adolescents, anxiety and depression are associated with interpersonal conflicts with family and friends, which can further contribute to disruptions in functioning. This case study explores the effectiveness of using cognitive behavioral therapy (CBT) with a 14-year-old white male with generalized anxiety disorder (GAD) and persistent depressive disorder (PDD) via telehealth during the COVID-19 pandemic. Treatment was divided into two phases, with the first phase occurring over 20 sessions and the second phase occurring over nine sessions for a total of 29 sessions. In the first phase, the Unified Protocol for Adolescents (UP-A) was flexibly implemented to target emotion regulation, behavioral skills, and cognitive restructuring. The second phase focused on family dynamics and targeted effective communication and collaborative problem-solving. Outcome data showed significant reductions in anxiety symptoms and slight reductions in depressive symptoms as well moderate improvements in peer relationships. These results provide support for using the UP-A to target internalizing symptoms in adolescents but also highlight the importance of addressing the family system in treatments. Treatment implications and recommendations for clinicians are discussed.

Compassion Focused Group Psychotherapy for attachment and relational trauma: Engaging people with a diagnosis of personality disorder

Article

Feb 2024
PSYCHOL PSYCHOTHER-T

Objectives The research aimed to evaluate an exploratory Compassion Focused Group Psychotherapy Programme and the impact on participants' experiences of self‐criticism, usage of services and general wellbeing. Participants included patients with a history of complex attachment and relational trauma (A&RT), who might attract a diagnosis of personality disorder. Design This study utilised a quasi‐experimental non‐randomised within subject controlled design for the evaluation of the efficacy of the programme. Methods Participants were recruited from tertiary care services. The programme consisted of a 12‐week Preparation and Engagement intervention (PEG) which was Compassionate Mind Training and Psychoeducation, followed by a 40‐week Compassion Focused Trauma Group intervention. The cohort was then followed up after 12 months during which period they received treatment as usual. A comprehensive selection of self‐report measures was administered at various points during the therapeutic process and following completion of the group interventions. Results The results of the research showed that the provision of a long‐term, slow‐paced, Compassion Focused Group Psychotherapy intervention, resulted in significant changes across all measures which were maintained at 12‐month follow‐up. These significant results were maintained following intention to treat and reliable change analyses. These data were supported by a significant reduction in service usage and a significant increase in engagement in employment and education. Conclusions This study has identified that within Compassion Focused Group Psychotherapy, there is a therapeutic process of establishing group‐based safeness as a necessary precursor to cultivating compassion and reworking early shame‐based trauma memories.

Designing and Evaluating a Psychological Intervention for Individuals with Multiple Complex Needs

Article

Dec 2023

Randomized Trial of an Organizational Implementation Strategy to Improve Measurement-Based Care Fidelity and Youth Outcomes in Community Mental Health

Article

Dec 2023
J AM ACAD CHILD PSY

Exploring the number of web-based behavioral health coaching sessions associated with symptom improvement in youth: Observational retrospective analysis (Preprint)

Article

Full-text available

Sep 2023

Background Rates of anxiety and depression have been increasing among children and adolescents for the past decade; however, many young people do not receive adequate mental health care. Digital mental health interventions (DMHIs) that include web-based behavioral health coaching are widely accessible and can confer significant improvements in youth anxiety and depressive symptoms. However, more research is necessary to determine the number of web-based coaching sessions that confer clinically significant improvements in anxiety and depressive symptoms in youth. Objective This study uses data from a pediatric DMHI to explore the number of web-based coaching sessions required to confer symptom improvements among children and adolescents with moderate or moderately severe symptoms of anxiety and depression. Methods We used retrospective data from a pediatric DMHI that offered web-based behavioral health coaching in tandem with self-guided access to asynchronous chat with practitioners, digital mental health resources, and web-based mental health symptom assessments. Children and adolescents who engaged in 3 or more sessions of exclusive behavioral health coaching for moderate to moderately severe symptoms of anxiety (n=66) and depression (n=59) were included in the analyses. Analyses explored whether participants showed reliable change (a decrease in symptom scores that exceeds a clinically established threshold) and stable reliable change (at least 2 successive assessments of reliable change). Kaplan-Meier survival analyses were performed to determine the median number of coaching sessions when the first reliable change and stable reliable change occurred for anxiety and depressive symptoms. Results Reliable change in anxiety symptoms was observed after a median of 2 (95% CI 2-3) sessions, and stable reliable change in anxiety symptoms was observed after a median of 6 (95% CI 5-8) sessions. A reliable change in depressive symptoms was observed after a median of 2 (95% CI 1-3) sessions, and a stable reliable change in depressive symptoms was observed after a median of 6 (95% CI 5-7) sessions. Children improved 1-2 sessions earlier than adolescents. Conclusions Findings from this study will inform caregivers and youth seeking mental health care by characterizing the typical time frame in which current participants show improvements in symptoms. Moreover, by suggesting that meaningful symptom improvement can occur within a relatively short time frame, these results bolster the growing body of research that indicates web-based behavioral health coaching is an effective form of mental health care for young people.

Impact of Polytherapy on Memory Functioning in Patients With Drug-Resistant Epilepsy: The Role of Attention and Executive Functions

Article

Nov 2023
ARCH CLIN NEUROPSYCH

Objective The aim was to examine the effect of polytherapy (i.e., the number of administered anti-seizure medications (ASMs)) on memory, and whether the interaction between the number of ASMs and attentional/executive functioning affect presurgical memory functioning and postsurgical memory changes in patients with drug-resistant epilepsy. Methods Two studies were carried out. Study 1 consisted of a presurgical assessment of 125 adult patients, in which attention/executive function (EpiTrack screening tool) and memory were assessed (cross-sectional study). Of them, 72 patients underwent a second postsurgical evaluation, in which memory was assessed (Study 2). Patients were distributed into groups based on EpiTrack performance and number of ASMs. Results The interaction between the number of ASMs and the attentional/executive functioning significantly affected presurgical memory, with patients with impaired EpiTrack performance taking three-four ASMs having poorer scores than patients with intact EpiTrack performance taking three-four ASMs (for all, p < .0001). This interaction also affected postsurgical memory changes, with patients with impaired Epitrack performance taking three-four ASMs having higher postsurgical decline than those with intact Epitrack performance taking three-four ASMs (for all, p < .005). No differences were found in patients taking two ASMs. Furthermore, the number of ASMs was associated with presurgical memory performance and postsurgical memory changes only in patients with impaired EpiTrack performance (for all, p < .05). Conclusions Our findings underline the utility of EpiTrack, together with the clinical information on the number of prescribed ASMs, to corroborate the impact of polytherapy on memory and to optimize the prediction of postsurgical memory changes.

The Dynamic Relationship of Negative Emotional Content in the Context of Trauma-Focused Writing Interventions on Improvements in Cognitive Reappraisal: A Pilot Study

Article

Full-text available

Dec 2023

Objective: Writing about traumatic experiences is beneficial for the reduction of posttraumatic stress symptoms, yet little research has examined the linguistic content of trauma-focused writing interventions. The current pilot study had two aims (a) characterize changes in linguistic features in two trauma-focused writing interventions; and (b) examine how changes in linguistic content may be associated with proposed mechanisms of change in trauma treatment (i.e., emotion regulation, cognitive reappraisal, and experiential avoidance). Method: Data were a secondary analysis of a proof-of-concept trial of written exposure therapy (WET) compared to trauma-focused expressive writing. Participants (N = 33, 76% female) completed five virtual sessions and measures of emotion regulation, posttraumatic cognitions, and experiential avoidance. Reliable change was calculated for each mechanism pre/postintervention. Linguistic inquiry and word count (Boyd et al., 2022) was used to analyze linguistic content (i.e., negative emotion words, past tense, cognitive processing, and death-related content). Results: Group differences emerged in slopes of narrative content across time for negative emotion words (b = 0.3, p = .008), past tense (b = −1.45, p < .01), and causal language (b = 0.39, p = .002). Contrary to expectations, only the slope of change in negative emotion words was associated with reliable changes in posttraumatic cognitions (b = −0.59, p = .023). Conclusions: Findings contribute evidence to support the use of negative emotion words early in treatment as a potentially influential target for improving posttraumatic cognitions in WET.

Can psychopathy be prevented? Clinical, neuroimaging, and genetic data: an exploratory study

Article

Full-text available

Nov 2023
CHILD NEUROPSYCHOL

The aim of the study was to explore the relationship among brain functional activations elicited by an emotional paradigm, clinical scores (PTSD, anxiety, and depression), psychopathic traits, and genetic characteristics (5-HTTLPR) in a group of severely maltreated children compared to a healthy control group before and after the implementation of a Trauma Focused-Cognitive Behavioral Therapy. The final sample consisted of an experimental group of 14 maltreated children (mean age = 8.77 years old, S.D. = 1.83) recruited from a non-governmental shelter in Mexico City for children who had experienced child abuse and a control group of 10 children from the general population (mean age = 9.57 years old, S.D. = 1.91). Both groups were matched according to age and gender and were assessed before and after the implementation of the aforementioned therapy by means of clinical scales and an emotional paradigm that elicited brain activations which were recorded through functional magnetic resonance imaging. Genotyping of the 5-HTTLPR poly-morphism was made at first assessment. A region of interest analysis showed amygdala hyperactivation during exposure to fear and anger stimuli in the maltreated children before treatment. Following therapy, a decrease in brain activity as well as a decrease in clinical symptoms were also observed. 5-HTTLPR polymorphism did not show any effect on the severity of clinical symptoms in maltreated children. Trauma-Focused Behavioral Therapy may help reorganize the brain's processing of emotional stimuli. These observations reveal the importance of an early intervention when the mechanisms of neuroplasticity may be still recruited. ARTICLE HISTORY

Promoting couples’ resilience to relationship obsessive compulsive disorder (ROCD) symptoms using a CBT-based mobile application: A randomized controlled trial

Article

Full-text available

Oct 2023

Relationship Obsessive Compulsive Disorder (ROCD) is a disabling form of obsessive-compulsive disorder (OCD) centering on interpersonal relationships. Previous findings suggest ROCD symptoms are particularly detrimental to romantic relationships. In this randomized controlled trial (RCT), we assessed influence a CBT-based mobile application used by both partners on resilience to ROCD symptoms, cognitions, and relationship dissatisfaction. The app consists of brief, daily exercises targeting OCD symptoms, related cognitions and attachment insecurities. Heterosexual couples (Ncouples = 103; Mage = 26.15) were randomly assigned to individually use a mobile application for 15 days (n = 49 couples) or to a control group (n = 54 couples). All participants completed questionnaires at baseline (T1), 15 days from baseline (T2), and 45 days from baseline (T3). All couples also underwent an ROCD resilience task at T2. Intention-to-treat analyses revealed that, in contrast to the control group, couples who used the app exhibited enhanced resilience in the resilience task, as well as measures of ROCD symptoms, cognitions, and relationship dissatisfaction. These observed effects persisted even at the 1-month follow-up. Concurrent use of brief mobile delivered cognitive training by both romantic partners may foster resilience in romantic couples.

Using conversational AI to facilitate mental health assessments and improve clinical efficiencies within psychotherapy services in a large real-world dataset (Preprint)

Article

Full-text available

Jan 2023

Background Most mental health care providers face the challenge of increased demand for psychotherapy in the absence of increased funding or staffing. To overcome this supply-demand imbalance, care providers must increase the efficiency of service delivery. Objective In this study, we examined whether artificial intelligence (AI)–enabled digital solutions can help mental health care practitioners to use their time more efficiently, and thus reduce strain on services and improve patient outcomes. Methods In this study, we focused on the use of an AI solution (Limbic Access) to support initial patient referral and clinical assessment within the UK’s National Health Service. Data were collected from 9 Talking Therapies services across England, comprising 64,862 patients. Results We showed that the use of this AI solution improves clinical efficiency by reducing the time clinicians spend on mental health assessments. Furthermore, we found improved outcomes for patients using the AI solution in several key metrics, such as reduced wait times, reduced dropout rates, improved allocation to appropriate treatment pathways, and, most importantly, improved recovery rates. When investigating the mechanism by which the AI solution achieved these improvements, we found that the provision of clinically relevant information ahead of clinical assessment was critical for these observed effects. Conclusions Our results emphasize the utility of using AI solutions to support the mental health workforce, further highlighting the potential of AI solutions to increase the efficiency of care delivery and improve clinical outcomes for patients.

Preventing Mental Health Problems in Children After High Conflict Parental Separation/Divorce Study: An Optimization Randomized Controlled Trial Protocol

Article

Sep 2023

Acceptability, feasibility and preliminary efficacy of a compassion‐based cognitive behavioural intervention for low self‐esteem in sexual minority young adults

Article

Sep 2023

Low self‐esteem can impair daily functioning and is a risk or maintenance factor for several mental health problems. Sexual minority young adults, for example, those identifying as lesbian, gay or bisexual, on average have lower self‐esteem than their heterosexual peers. Compassion‐based interventions for low self‐esteem might be especially beneficial for sexual minority young adults, whose higher levels of shame and self‐criticism are likely to be contributing to maintenance of their low self‐esteem. This study explored the acceptability, feasibility and preliminary efficacy of a new compassion‐based cognitive behavioural intervention for low self‐esteem tailored to sexual minority young adults. Participants were a community sample of 24 sexual minority young adults aged 16–24 experiencing clinically significant low self‐esteem. An uncontrolled pre‐/post‐design was used with qualitative feedback and quantitative outcomes. Self‐report standardised measures were completed at baseline, pre‐intervention, intervention mid‐point, post‐intervention and 2‐month follow up. Preliminary efficacy was examined through post‐intervention changes in self‐esteem, functioning, anxiety and depression. Potential mechanisms of change were examined through changes in self‐compassion, self‐criticism and unhelpful coping responses to minority stress. Results showed good acceptability and feasibility and preliminary evidence of intervention efficacy for improving self‐esteem, functioning, depression and anxiety. There was evidence for improvement in self‐compassion and reduction in self‐criticism, and these constructs could be investigated in future studies as treatment mediators. Randomised controlled studies are needed to further examine efficacy of the intervention.

10‐session Cognitive Behavioural Therapy (CBT-T) for Eating Disorders: A Systematic Review and Narrative Synthesis

Article

Full-text available

Sep 2023
INT J COGN THER

To review the literature examining the effectiveness and efficacy of a cognitive behavioural therapy (CBT) for eating disorders delivered in ten sessions for those who are not underweight (CBT-T). A systematic search of the literature (MEDLINE, EMBASE, PsycINFO, Scopus and ProQuest) was conducted to identify relevant publications to date at the time of March 2022 (re-run in May 2023). Intervention studies of any study design that investigated CBT-T offering outcome data at least pre- to post- intervention for eating disorder and related outcomes were included. Results were reported for treatment attrition, abstinence, remission, eating disorder psychopathology, disordered eating behaviours, psychosocial impairment, depression and anxiety and synthesised using a narrative synthesis framework. The Effective Public Health Practice Project (EPHPP) quality assessment tool (Thomas et al., 2004) was used to assess the quality of included studies. Outcomes for 555 people who received CBT-T across eight studies (one randomised control trial and seven non-randomised studies) were synthesised. Support was found for the effectiveness and efficacy of CBT-T for a range of non-underweight eating disorders, with respect to eating disorder psychopathology, disordered eating behaviours, psychosocial impairment, abstinence and remission. CBT-T also led to improvements for depression and anxiety symptoms. CBT-T appears to improve eating disorder and co-morbid outcomes for people with non-underweight eating disorders within ten sessions, with comparable results to standard-length CBT for eating disorders (CBT-ED). Although results for CBT-T are promising, there were concerns with the quality of the studies. Future research is required to strengthen the evidence base with larger, higher-quality studies which compare CBT-T directly with recommended psychological treatments, such as standard-length CBT-ED.

Behavioral Activation: Effect on Bogotan Adults with Depression in Face- to-Face and Online Sessions

Article

Full-text available

Sep 2023

Esta investigación estimó el efecto del Tratamiento Breve de Activación Conductual para Depresión (BATD-R) en dos modalidades y dos formatos, sobre la frecuencia de conductas saludables y evitativas, en cinco adultos con depresión moderada. Se evaluaron cambios en severidad de la depresión, percepción de reforzamiento medioambiental, sintomatología emocional y factores de cambio de la Activación Conductual. Diseño de caso único A-B-Ar-C con seguimiento, A línea de base, B inicio del componente activo del tratamiento, Ar retirada forzada por medidas de asilamiento preventivo por covid-19, C continuidad de la intervención con transición de formato grupal a individual y de modalidad presencial a online. El análisis visual y pruebas Tau-U mostraron efectos significativos sobre la frecuencia de conductas saludables en los contrastes de la fase A con las demás, con incremento significativo (p< .05) y tamaños de efecto grandes (Tau-U> .711) y muy grandes (Tau-U> .955). En las conductas evitativas con valores Tau-U negativos, significativos (p< .05) y de tamaño del efecto moderado (Tau-U< -.467) y grande (Tau-U< -.634). Los contrastes de las pruebas objetivas respaldan los hallazgos de las medidas repetidas. El BATD-R fue efectivo y mostró versatilidad, compatibilidad y adaptabilidad dentro de sus formatos y modos de administración. https://www.revistas.unam.mx/index.php/acom/article/view/86453

Brief relationship support as a selective suicide prevention intervention: Piloting the Relationship Checkup in veteran couples with relationship and mental health concerns

Article

Aug 2023
SUICIDE LIFE-THREAT

Introduction: Close relationship problems play a key role in many contemporary theories of suicide. However, the potential of relationship support in suicide prevention is understudied. This study explores the feasibility, safety, acceptability, and promise of utilizing the 3-session Relationship Checkup (RC) in veterans with mental health and romantic relationship concerns. Methods: We conducted a single-arm pilot of telehealth RC in veterans with a positive mental health screen and their romantic partners. Couples completed baseline and post-treatment assessments of study outcomes. Results: Feasibility analyses showed we were able to recruit an elevated-risk sample (30% history of attempts or interrupted attempts), take them through the service (90% treatment completion), and had minimal harm events (no suicidal behavior, no physical harm in arguments). Multimethod acceptability analyses suggested high satisfaction with the program, though some desired more intensive services. Couples reported improvements in relationship functioning, emotional intimacy, thwarted belongingness, depression, and posttraumatic stress. Perceived burdensomeness only improved for identified patients and drinking did not change for either partner. Conclusion: The RC is a feasible, safe, and acceptable strategy for providing relationship support to couples at elevated risk. Although further randomized trials are needed, RC shows promise to reduce relationship-level and individual-level suicide risk factors.

Effectiveness of attachment-based compassion therapy to reduce psychological distress in university students: a randomised controlled trial protocol

Article

Full-text available

Aug 2023

Introduction Higher education, particularly university, is a challenge for many students that can lead to their mental health being seriously affected. The stress to which they are subject throughout their time at university can lead to anxiety and depression. “Third wave” psychotherapies, including compassion-based therapy, have been used to improve psychological outcomes, such as stress, anxiety, emotional distress and well-being. There are some signs that third wave psychotherapies reduce psychological distress in university students, but more and higher-quality studies are needed. In this randomised controlled trial (RCT), we hypothesise that the provision of attachment-based compassion therapy (ABCT) will be more effective than an active control group based on relaxation therapy for improving psychological distress in university students. Methods and analysis A two-arm RCT will be conducted involving 140 university undergraduate and postgraduate students from the University of Zaragoza and the National University of Distance Education (UNED) who reside in the autonomous community of Aragon, Spain. Interventions with either ABCT or relaxation therapy will be implemented, with an allocation ratio of 1:1 between groups. Both interventions will last six weeks and consist of six weekly group sessions lasting 1.5 h each. Data will be collected before and after the intervention, and there will be a follow-up at six months. The primary outcome will be psychological distress at post-intervention. Secondary outcomes will be depression, anxiety, stress and burnout symptoms, affectivity and emotional regulation. Attachment style, experiential avoidance, compassion (for others/oneself) and mindfulness skills will be measured as potential mechanistic variables. Intention-to-treat analysis will be performed using linear mixed regression models. The clinical significance of improvements will be calculated. Potential side effects will be monitored by an independent clinical psychologist. Ethics and dissemination This study was approved by the Clinical Research Ethics Committee of Aragón. Participant data will remain anonymous, and results will be submitted to peer-reviewed open-access journals and disseminated via conferences. Clinical Trial Registration ClinicalTrials.gov, identifier NCT05197595.

Effectiveness of training in expressing positive emotions, reacting to change and greeting peers after childhood traumatic brain injury: a single-case experimental study

Article

Full-text available

Jul 2023

Background Social cognitive deficits are common after traumatic brain injury (TBI). The participant in this single-case experimental design (SCED) was 7 years old when he sustained a severe TBI. After 2 years in rehabilitation, he continues to show deficits in social cognition.Objective To determine the effectiveness of three interventions, each aimed at improving a behavior altered by social cognition deficits. These behaviors were: (1) expression of positive emotions, (2) reacting to changes in plans, and (3) greeting classmates.Method An A-B-A’ design was used for each behavior. In addition, each behavior was targeted with a rehabilitation program applied over 10 sessions.ResultsFor the first behavior, changes between phases B-A’ (NAP = 0.712) and A-A’ (NAP = 0.864) indicated improvements in the child’s ability to express positive emotions. In the second behavior, changes in the intensity of reactions between phases B and A’ (NAP = 0.815) and A vs. A’ (NAP = 0.834) indicated that the child adapted to changes in a plan and to unexpected situations in a more adaptive way. For the third behavior, changes in the number of greetings between phases A and B (NAP = 0.883) and A vs. A’ (NAP = 0.844) suggested that during the third phase of the study, the participant fully acquired the habit of greeting peers and increased his interactions with others.Conclusion While the participant showed improvements in all three targeted behaviors, due to the complexity of the third behavior, it is recommended that in future research, the intervention targeting social interactions should be applied over a longer timeframe to ensure that improvements are more stable in the long term.

A Pilot Trial of SPACE (Supportive Parenting for Anxious Childhood Emotions) in Autism

Article

Full-text available

Jun 2023
CHILD PSYCHIAT HUM D

Family accommodation describes changes parents make to their behavior, intended to alleviate their child’s distress, which stems from a psychopathology. In anxiety, studies show that accommodation alleviates distress in the short term but is associated with increased symptom severity, greater functional impairment, poorer treatment outcomes, increased caregiver burden and disruption to family functioning longitudinally. Research shows high prevalence of family accommodation of anxiety in autism. While the most common treatments for anxiety in autism are cognitive-behavior therapy and pharmacology, research is limited and other approaches must be considered. Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based, manualized treatment for anxiety targeting family accommodation, which has been found to be acceptable and efficacious in treating childhood anxiety. This pilot trial examined the feasibility, acceptability, treatment-satisfaction, and preliminary efficacy of SPACE for anxiety in autism. Parents of 15 autistic children (ages 6–10 years) with at least average cognitive abilities exhibiting high levels of anxiety participated in 13 weekly sessions of SPACE. Feasibility and acceptability were assessed through enrollment, attrition rates, and adverse events. Of 26 eligible families, 22 (84.62%) elected to participate, 15 of whom (68.18%) completed treatment. Parents rated the treatment as highly satisfactory. Anxiety symptom severity and family accommodation were significantly reduced following treatment, with 86.66% of participants showing reliable change post-treatment, and this reduction was preserved at 2-month follow-up. This study provides preliminary evidence that SPACE is feasible, acceptable, satisfactory, and produces improvement in anxiety in the autistic population. Trial registration number: NCT04747262 Date of registration: February 10, 2021

Clinical significance: A statistical appraoch to defining meaningful change in psychotherapy research

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