Important Mechanism Of Change Research Articles

Mindfulness-based cognitive therapy for chronic noncancer pain and prescription opioid use disorder: A qualitative pilot study of its feasibility and the perceived process of change.

Mindfulness-based interventions have a positive impact on pain, craving, and well-being in both patients with chronic pain and those with opioid use disorder (OUD). Although data are limited, mindfulness-based cognitive therapy (MBCT) might be a promising treatment for patients with chronic noncancer pain combined with OUD. The aim of this qualitative study was to explore the feasibility and process of change during MBCT in this particular population. In this qualitative pilot study, 21 patients who were hospitalized for rotation to buprenorphine/naloxone as agonist treatment for chronic pain and OUD were offered MBCT. Semistructured interviews were conducted to explore experienced barriers and facilitators to MBCT. Patients who participated in MBCT were also interviewed on their perceived process of change. Of 21 patients invited to participate in MBCT, 12 initially expressed interest but only four eventually participated in MBCT. The timing of the intervention, group format, somatic complaints, and practical difficulties were identified as the main barriers to participation. Facilitating factors included having a positive attribution toward MBCT, an intrinsic motivation to change, and practical support. The four MBCT participants mentioned several important mechanisms of change, including reduction of opioid craving and improved coping with pain. MBCT offered in the current study was not feasible for the majority of patients with pain and OUD. Changing the timing of MBCT by providing it at an earlier stage of the treatment and offering MBCT in an online format may facilitate participation.

Longitudinal associations between perceived stress and anhedonia during psychotherapy

BackgroundChronic stress alters reward sensitivity and contributes to the emergence of anhedonia. In clinical samples, the perception of stress is a strong predictor of anhedonia. While there is substantial evidence demonstrating psychotherapy reduces perceived stress, little is known regarding the effects of treatment-related decreases in perceived stress on anhedonia. MethodsThe current study investigated reciprocal relations between perceived stress and anhedonia using a cross-lagged panel model approach in a 15-week clinical trial examining the effects of Behavioral Activation Treatment for Anhedonia (BATA), a novel psychotherapy to treat anhedonia, compared to a Mindfulness-Based Cognitive Therapy (MBCT) comparison intervention (ClinicalTrials.gov Identifiers NCT02874534 and NCT04036136). ResultsTreatment completers (n = 72) experienced significant reductions in anhedonia (M = −8.94, SD = 5.66) on the Snaith-Hamilton Pleasure Scale (t(71) = 13.39, p < .0001), and significant reductions in perceived stress (M = −3.71, SD = 3.88) on the Perceived Stress Scale (t(71) = 8.11, p < .0001) following treatment. Across all treatment-seeking participants (n = 87), a longitudinal autoregressive cross-lagged model revealed significant paths showing that higher levels of perceived stress at treatment Week 1 predicted reductions in anhedonia at treatment Week 4; lower levels of perceived stress at Week 8 predicted reductions in anhedonia at Week 12. Anhedonia did not significantly predict perceived stress at any stage of treatment. ConclusionsThis study showed specific timing and directional effects of perceived stress on anhedonia during psychotherapy treatment. Individuals with relatively high perceived stress at the start of treatment were more likely to report relatively lower anhedonia a few weeks into treatment. At mid-treatment, individuals with low perceived stress were more likely to report lower anhedonia towards the end of treatment. These results demonstrate that early treatment components reduce perceived stress, thus allowing for downstream changes in hedonic functioning during mid-late treatment. The findings presented here suggest it will be critically important for future clinical trials evaluating novel interventions for anhedonia to measure stress levels repeatedly, as an important mechanism of change. Trial nameDevelopment of a Novel Transdiagnostic Intervention for Anhedonia - R61 Phase. Trial URLhttps://clinicaltrials.gov/ct2/show/NCT02874534. Trial registration numberNCT02874534.

Psychosocial functioning mediates change in motor and cognitive function throughout neurorehabilitation for adults with acquired brain injury (ABI-RESTaRT)

ObjectivesThis study aimed to evaluate the mediational role of change in psychosocial abilities, adjustment and participation on change in motor and cognitive function from admission to discharge from a staged community-based brain injury rehabilitation (SCBIR) service in Western Australia, 2011–2020.MethodsA retrospective cohort study of n = 324 adults with ABI enrolled in SCBIR using routinely collected rehabilitation outcome measures data. Motor and cognitive function were assessed with the UK Functional Independence and Assessment Measure and psychosocial function with the Mayo-Portland Adaptability Inventory-4. Six multilevel mediation regression analyses were conducted to determine whether change in psychosocial function (abilities, adjustment and participation) mediated change in motor and cognitive function from admission to discharge.ResultsParticipants demonstrated clinically significant improvements in both motor (+ 11.8, p < 0.001) and cognitive (+ 9.5, p < 0.001) functioning from admission to discharge. Statistically significant improvements in psychosocial abilities (− 4.8, p < 0.001), adjustment (− 2.9, p = 0.001) and participation (− 2.5, p < 0.001) were also seen but were not clinically significant. Mediation analyses showed that participation accounted for 81% of improvements in motor function at discharge and 71% of cognitive function improvements. Adjustment accounted for 26% and 32% of change in motor and cognitive function, respectively. Abilities accounted for 60% of change in cognitive function but did not significantly influence change in motor function. Changes in psychosocial participation fully mediated change in motor function during neurorehabilitation.ConclusionsPsychosocial function, particularly participation, is an important driver of motor and cognitive recovery throughout neurorehabilitation. Functional rehabilitation programs should target psychosocial improvement as an important mechanism of change.

Mediators of quality of life change in people with severe psychotic disorders treated in integrated care: ACCESS II study.

Patients with severe psychotic disorders exhibit a severely reduced quality of life (QoL) at all stages of the disease. Integrated care often led to an improvement in QoL. However, the specific mediators of QoL change are not yet well understood. The ACCESS II study is a prospective, long-term study investigating the effectiveness of an integrated care program for people with severe psychotic disorders (IC-TACT) that includes Therapeutic Assertive Community Treatment within a care network of in- and outpatient services at the University Medical Center Hamburg-Eppendorf, Germany. We examined longitudinal associations between QoL and the hypothesized mediators of change (i.e., negative symptoms, depression, and anxiety), using cross-lagged panel models. The sample includes 418 severely ill patients treated in IC-TACT for at least 1 year. QoL increased, whereas symptom severity decreased significantly from baseline to 6-month follow-up (p-values ≤ 0.001), and remained stable until 12-month follow-up. QoL and symptom severity demonstrated significant auto-correlated effects and significant cross-lagged effects from QoL at baseline to negative symptoms (6 months, β = -0.20, p < 0.001) to QoL (12 months, β = -0.19, p < 0.01) resulting in a significant indirect, mediated effect. Additionally, negative symptoms after 6 months had a significant effect on the severity of depression after 12 months (β = 0.13, p < 0.05). Negative symptoms appear to represent an important mechanism of change in IC-TACT indicating that improvement of QoL could potentially be achieved through optimized intervention on negative symptoms. Moreover, this may lead to a reduction in the severity of depression after 12 months.

Mentalizing Mediates the Association between Narcissism and Psychotherapeutic Treatment Outcome in a Mixed Clinical Sample

Introduction: Pathological narcissism has been a challenge for the success of psychological treatment, whereas mentalizing has turned out to be an important mechanism of change in psychotherapy. This study focused on the classic narcissistic self (CNS) (i.e., narcissistic grandiosity) as predictor of the outcome. It further investigated whether mentalizing mediates this relation. Methods: A mixed clinical sample of 205 patients was investigated. The CNS scale of the Narcissism Inventory and the Mentalization Questionnaire was used to measure the features of narcissistic grandiosity and the capacity to mentalize, respectively. The symptom outcome was assessed with the Hamburg Modules for the Assessment of Psychosocial Health. Results: Contrary to our expectations, we did not find a direct association between narcissistic grandiosity and a decrease in symptoms. However, mentalizing was found to mediate the association between the CNS as well as between the narcissistic furor and outcome. Conclusion: Our results confirm the ambiguity concerning the clinical significance of narcissistic grandiosity. However, in order to improve the treatment outcome in patients with narcissistic features, especially narcissistic furor, individualized treatment plans might consider introducing interventions that enhance the capacity to mentalize.

Alliance ruptures and resolutions in short-term psychoanalytic psychotherapy for adolescent depression: An empirical case study

ABSTRACT Most research on alliance rupture-repair processes in psychotherapy has been carried out with adults and little is known about the alliance dynamics with adolescents, especially in psychodynamic treatments. Objective: This study aimed to better understand the process of alliance rupture–resolution and its role in a good-outcome case of a depressed adolescent treated with short-term psychoanalytic-psychotherapy (STPP). Method: A longitudinal, mixed-methods empirical single-case approach was employed. Multiple sources of information (questionnaires, interviews, sessions recordings) from various perspectives (adolescent, therapist, observer) were assembled and analysed. Results: The different sources of evidence converged and showed that, despite the presence of frequent alliance ruptures, patient and therapist managed to resolve these and develop a good and collaborative relationship. Both patient and therapist regarded the evolution in their relationship as the treatment factor mainly responsible for the positive changes experienced by the adolescent. Based on both theoretical and empirical data, a preliminary model of how to explore and repair alliance ruptures in STPP is presented. Conclusion: This study illustrates one way of applying an empirical, mixed-method approach to a single case. Its finding supports the idea that the process of repairing ruptures is an important mechanism of change. Strengths, limitations, and possible implications are discussed.

What works for whom: A realist synthesis of neighbourhood interventions for families in the community

Neighbourhood interventions are important for creating supportive structures for parents and children and for other community members. Little is known, however, about what works for whom in what situation. The aim of this study was to gain a better understanding of what works for whom in community interventions in the neighbourhood. Realist synthesis was used as a review methodology to examine community interventions. Six databases were searched for studies published between January 1st, 2000 and May 8th, 2020 and 28 community programs reported in 34 publications were included. Multiple rounds of coding and several discussions with experts and the project team were conducted to analyze these studies and programs, and to understand underlying assumptions of neighbourhood interventions. This resulted in the definition of ten important mechanisms of change in specific contexts. These were found on two levels: on an interpersonal level (e.g. social support) and on a community level (e.g. social norms). Positive mechanisms of change varied from supportive professionals to participants in the intervention, to co-production in developing the intervention. Negative mechanisms were only found on the community level and were related to professionals’ and community members’ skills. Mechanisms of change were found to be related to specific contexts, such as implementation strategies and the type of intervention. Professionals and municipalities can use these mechanisms of change to improve their interventions and neighbourhood practices.

Dynamics of risk: Recent changes in psychological inflexibility precede subsequent changes in returning US veterans' posttraumatic stress.

As a malleable risk-factor, psychological inflexibility is implicated in the development and maintenance of posttraumatic stress symptoms (PTS). Unfortunately, limited research has addressed whether changes in psychological inflexibility are antecedent to changes in PTS severity over time, or whether such changes are mutually dependent. Utilizing bivariate latent difference score modeling, this longitudinal study sequenced intraindividual changes in psychological inflexibility and PTS severity within a sample of 305 returning US veterans. Veterans' self-reported psychological inflexibility and PTS severity were assessed quarterly over 1 year. Results indicated that early reductions in psychological inflexibility potentiated later declines in veterans' PTS severity, accounting for veterans' prior levels of psychological inflexibility and PTS severity. These findings underscore the unique role of changes in psychological inflexibility as an important mechanism of change in PTS severity and provide empirical support for an antecedent model of the role of psychological inflexibility in PTS recovery.

Initial validation of the Defense Mechanisms Rating Scales Q-sort: A Comparison of Trained and Untrained Raters

Objectives: Defense mechanisms underlie a range of healthy and pathological psychological phenomena and are important mechanisms of change in psychotherapy. Thus, the identification of defense mechanisms in clinical work is crucial, however, measures commonly used for their assessment have various limitations. The Defense Mechanisms Rating Scale Q-set (DMRS-Q; Di Giuseppe, 2014) was developed to address these problems, and to provide an easy-to-use, valid, and reliable tool for the assessment of defense mechanisms. The present study aimed to evaluate the reliability of the DMRS-Q when used by trained versus untrained coders, and to examine the criterion validity of the DMRS-Q in relation to its original observer-rated version, the Defense Mechanisms Rating Scale (DMRS; Perry, 1990). Methods: Collateral sessions ( n = 13) with parents of children with externalizing problems were coded with the DMRS-Q by trained and untrained raters, and on the DMRS by an expert rater. Results: We found that both trained and untrained coders were able to assess most defense categories and levels with moderate to excellent reliability on the DMRS-Q, and that untrained coders’ reliability was comparable although slightly lower than untrained coders’ reliability. Moreover, our results indicate the generally good criterion validity of the DMRS-Q when compared to the original DMRS. Discussion: These findings suggest that the DMRS-Q is a promising measure that can be used by clinicians and researchers at all levels of training and with minimal knowledge of defense mechanisms as a reliable and valid method to assess defense mechanisms in clinical settings.

Low Estradiol May Not Impede Cognitive Restructuring in Women With Anxiety Disorders.

Prior research suggests that estradiol may moderate fear extinction in animal models and humans. Based on these findings, estradiol may also moderate cognitive reappraisal, which is theorized to be an important mechanism of change in extinction-based therapy (exposure therapy). We compared cognitive restructuring (CR) skills acquisition and outcome between women with primary anxiety disorders who had high versus low estradiol using a standardized CR task that closely resembles clinical practice. As a proxy of CR outcome, we assessed subjective distress ratings before and after the task and psychophysiological arousal (heart rate and electrodermal activity) throughout the task. Contrary to predictions, results showed that CR skills acquisition and outcome did not differ between the high and low estradiol groups. Although both groups demonstrated reductions in negative affect and skin conductance responses during the CR task, suggesting that participants were able to acquire CR skills and use them effectively to regulate distress, the groups did not differ with respect to CR ability or outcome. The findings suggest that estradiol may not moderate cognitive reappraisal, and may have more of an effect on basic habituation and extinction processes instead.

Analogy as driving force of language change: a usage-based approach towoanddaclauses in 17th and 18th century German

AbstractThis paper presents a case study conducted on 17th and 18th century German corpora, confirming that both attraction and differentiation are important mechanisms of change, which interact with socio-symbolic properties of constructions. The paper looks at the frequencies and semantics ofwo‘where’ clauses at the beginning of the New High German period, which are compared to the frequencies and semantics of the connectorda‘there, since’ in the same period. The study reveals that the subordinating connectorswoanddaoverlapped in their functions and were highly polysemous (or semantically vague), establishing spatial, temporal, causal, conditional, and contrast links between clauses. This suggests that the connectors had become functionally similar by means of mutual attraction; however, they differed in that they belonged to different registers. Over the course of the 18th century, the polysemy ofwoanddaclauses reduced. Being gradually confined to one single meaning, the connectors became less similar. This differentiation occurs because the connectors aligned to distinct high-level schemas in the associative network. The study confirms that analogy is crucial to both attraction and differentiation of functionally overlapping constructions. While attraction involves analogy of specific instances of constructions, differentiation occurs in analogy to high-level abstract constructions in the associative network.

The Role of Self-Compassion, Dispositional Mindfulness, and Emotion Regulation in the Psychological Health of Family Carers of Older Adults

ABSTRACT Objectives This study explored the role of compassion and dispositional mindfulness in the psychological health of family carers of older adults and tested for potential mediating effects of emotion regulation difficulties and adaptive coping strategies. Methods A sample of 141 family carers of adults aged 65 years or older with chronic conditions completed a cross-sectional survey between July – December 2019. The survey included self-report scales that measured: self-compassion, compassion for others, compassion from others, dispositional mindfulness, depression, anxiety, stress, emotion- and problem-focused coping strategies, and difficulties in emotion regulation. Results Path analyses found that increased self-compassion and increased dispositional mindfulness was associated with lower psychological distress, and that this was mediated by reduced difficulties in emotion regulation. The model had excellent fit, explaining 64.8% of the variance in psychological distress, and 52.2% of the variance in emotion regulation difficulties. Conclusions Self-compassion and dispositional mindfulness may help buffer the psychological distress of family carers of older adults, and adaptive emotion regulation is an important mechanism of change in these relationships. Clinical Implications Interventions that aim to cultivate self-compassion and mindfulness could be clinically useful in reducing psychological distress within populations of family carers of older adults by promoting adaptive emotion regulation.

Change in dysfunctional attitudes and attachment in interpersonal psychotherapy for depressed adolescents

ABSTRACT This study examined changes in depressed adolescents’ reports of dysfunctional attitudes while receiving interpersonal psychotherapy (IPT-A) and the relationship between the change in dysfunctional attitudes and change in attachment anxiety and avoidance with IPT-A. Forty adolescents (age 12–17) participated in a 16-week randomized clinical trial of 4 adaptive treatment strategies that began with IPT-A and augmented treatment for insufficient responders by adding additional IPT-A sessions or the antidepressant medication, fluoxetine. Measures of attachment anxiety and avoidance (Experience in Close Relationships Scale—Revised [ECR-R]), dysfunctional attitudes (Dysfunctional Attitudes Scale [DAS]), and depression (Children’s Depression Rating Scale—Revised [CDRS-R]) were administered at baseline and weeks 4, 8, 12, and 16. Adolescents demonstrated a significant decrease in dysfunctional attitudes (DAS) over the course of treatment. Reductions in dysfunctional attitudes (DAS) were also significantly associated with reductions in attachment anxiety and avoidance (ECR-R), controlling for depression (CDRS-R). Our results suggest that change in adolescents’ attachment anxiety and avoidance may be an important mechanism of change in adolescents’ dysfunctional thinking patterns.

Going cashless: Change in institutional logic and consumption practices in the face of institutional disruption

This study explores how sudden disruptive changes lead to changes in institutional logic and associated consumption practices. The empirical context is provided by the demonetization of high-denomination currency in India in 2016. The findings reveal that micro-level consumption practices are embedded within macro-level social structures and institutions. Therefore, institutional changes lead to corresponding changes in the material, competence, and meaning dimensions of consumption practices. This study examines the neglected dimension of the delegitimation of consumption practices and markets. The study points to artifactual spatialization and indirect identification as important mechanisms of change in materiality, and sheds light on the microfoundations of institutions. It explores the sensemaking work of adjusting, adapting, adopting, and advocating by micro-actors and the sensegiving work of problematizing, enrolling, and facilitating by macro-actors. Thus, sensemaking and sensegiving enactments are conceptualized as institutional work.

Young people's trauma-related cognitions before and after cognitive processing therapy for post-traumatic stress disorder.

Cognitive processing therapy (CPT) is a psychotherapy for post-traumatic stress disorder (PTSD) with a broad evidence base. Change in trauma-related cognitions is considered its primary working mechanism. When trying to integrate a traumatic event into existing cognitive schemas, the adaptive mechanism is changing the schema (accommodation). However, PTSD patients frequently either change their schemas too much (over-accommodation), or cognitively distort the event (assimilation). We aimed to test the hypothesized connections between the three types of cognition and symptom load. This study adds to the literature using 'impact statements', essays on their trauma-related thoughts written by patients at the beginning and end of CPT, to investigate cognitive change and its relationship to symptomatic outcome. We analysed statements written by 31 adolescents and young adults who received developmentally adapted CPT (a longer treatment where CPT is the core component) in a randomized controlled trial. As expected, post-CPT statements contained more accommodated and fewer over-accommodated and assimilated clauses than pre-CPT statements. Correlations between cognition frequencies and concurrent symptom load were as expected for assimilation, and, in part, over-accommodation and accommodation. Decreased PTSD and depressive symptoms were correlated with increased accommodated thoughts. For over-accommodation and assimilation, however, expected correlations could not be shown. Our results support the notion that cognitive change is an important mechanism of change in CPT in a sample of younger, non-English-speaking clients.

Mindfulness for at Risk Youth: Understanding Substance Use and Important Mechanisms of Change

Mindfulness for at Risk Youth: Understanding Substance Use and Important Mechanisms of Change

Process expectations: Differences between therapists, patients, and lay individuals in their views of what works in psychotherapy.

In this study, we aimed to assess the degree to which individuals with varying levels of psychotherapeutic experience have predisposed ideas regarding what works in psychotherapy. Therapists (n = 107), patients (n = 97), and lay individuals with no prior experience in psychotherapy (n = 160) reported their process expectations and ranked seven mechanisms of change in the order of their perceived importance. Therapists rated emotional processing and patient-therapist relations as higher in importance than did patients and lay individuals, but patients and lay individuals rated cognitive and emotional reconstruction higher than did therapists. Furthermore, therapists ranked the exploration of unconscious contents as most important, while patients and lay individuals ranked cognitive control to be the most important mechanism of change. Therapists, patients, and lay individuals expect different mechanisms of change to take place in psychotherapy. Limitations and directions for future research are discussed.

“A definite feel‐it moment”: Embodiment, externalisation and emotion during chair‐work in compassion‐focused therapy

AbstractChair‐work is an experiential method used within compassion‐focused therapy (CFT) to apply compassion to various aspects of the self. This is the first study of CFT chair‐work and is focused on clients' lived experiences of a chair‐work intervention for self‐criticism. Twelve participants with depression were interviewed following the chair‐work intervention and the resulting data were examined using interpretative phenomenological analysis. Three superordinate themes were identified: “embodiment and enactment,” “externalising the self in physical form” and “emotional intensity.” The findings suggest the importance of accessing and expressing various emotions connected with self‐criticism, whilst highlighting the potential for client distress and avoidance during the intervention. The role of embodying, enacting and physically situating aspects of the self in different chairs is also suggested to be an important mechanism of change in CFT chair‐work. The findings are discussed in terms of clinical implications, emphasising how core CFT concepts and practices are facilitated by the chair‐work process.

To Mix or Not To Mix? A Meta-Method Approach to Rethinking Evaluation Practices for Improved Effectiveness and Efficiency of Psychological Therapies Illustrated With the Application of Perceptual Control Theory.

Progress in the development of more effective and efficient psychological therapies could be accelerated with innovative and nuanced approaches to research methodology. Therapy development has been dominated by a mono-methodology attitude with randomized controlled trials (RCTs) regarded as a “gold standard” despite the concept of a single methodology being ascribed gold standard status having been called into question. Rather than one particular methodology being considered superior to all others, the gold standard approach should be matching appropriate methodologies to important research questions. The way in which that matching should occur, however, is far from clear. Moving from a mono-methodological approach to mixed-method designs has not been straightforward. The ways in which methods should be mixed, to arrive at robust and persuasive answers to genuine research questions, is not entirely clear. In this paper, we argue that attention to the meta-methods underpinning all research designs will improve research precision and provide greater clarity about the contribution of any particular program of research to scientific progress in that field. From a meta-method perspective, the matter of what changed can be delineated from why or how these changes occurred. Different methods and different types of mixing can be justified for each meta question. A meta-method approach should make explicit the assumptions that guide the development of research designs and also promote the articulation of putative mechanisms that might be relevant. By paying greater attention to assumptions such as how causality occurs, and important mechanisms of change, the mixing of methodologies that are still not mainstream in this area such as routine outcome monitoring and evaluation and functional model building, can occur. By adopting methodologies that focus on learning about a program’s strengths and weaknesses rather than presiding over judgments of whether or not the program is deemed to be effective, we will move much closer to a position of being able to understand what programs under which conditions people find most helpful for their purposes.

Parents as Role Models: Associations Between Parent and Young Children's Weight, Dietary Intake, and Physical Activity in a Minority Sample.

Objective We examined the association between parent and child fruit and vegetable (F&V) intake, physical activity (PA), and body mass index in an ethnic minority and low-income sample. Methods The study sample consisted of 86 children ages 5-7years (80% Hispanic) and their parents. Three parent health variables (healthy weight, recommended F&V servings per day, and recommended weekly PA) were used to create a healthy role model index. Associations between the parent index and corresponding child health behaviors and weight were examined. Results Most parents (53.5%) were not healthy role models, 30.2% were limited healthy role models, 16.3% were good role models, and none were excellent role models; most parents and children did not meet guidelines for healthy weight, F&V intake, and PA. Parents who scored higher on the index were more likely to have children with higher levels of F&V. Furthermore, parents who had a healthy weight were 3.7 times more likely to have a child who had a healthy weight. Additionally, parents who were consuming the recommended servings of F&V per day were 10 times more likely to have children who were also consuming the recommended servings of F&V per day compared to parents who were not consuming the recommended servings of F&V per day. Conclusions for PracticeThese findings suggest the important role of parental modeling of healthy behaviors to their young children among minority/low-income families. Parents may serve as an important mechanism of change for children's health status by increasing their own healthy lifestyle behaviors.