Mechanisms Of Change In Therapy Research Articles

Only time will tell: Acute stress response patterns with time series analysis

Acute stress is often conceptualized as a response pattern that activates the fight-or-flight response via the sympathetic nervous system (SNS). However, other stress response patterns can manifest as well, such as parasympathetic nervous system (PNS) shutdown, and SNS-PNS coactive hypervigilance. Each response pattern engages many dimensions, including physiological, emotional, and behavioral. As stress unfolds over time, these patterns can change to adjust to the changing nature of the stressor. This proof of concept study introduces novel time series methodology to track the multidimensional patterns of acute stress. The defense cascade provides a model with which to understand and predict response patterns over the time course of an acute stressor. The time series methodology introduced in this study holds promise for identifying mechanisms of change in therapy and clinical settings.

Psychotherapy is still failing patients: revisiting informed consent—a response to Garson Leder

Compared with mainstream medicine and complementary and alternative therapies, the practice of psychotherapy has enjoyed a relative pass when it comes to ethical evaluation. Therefore, contributions to the, although slowly...

ПОРІВНЯЛЬНИЙ АНАЛІЗ І ШЛЯХИ ІНТЕГРАЦІЇ ПСИХОТЕРАПЕВТИЧНИХ ПІДХОДІВ СХЕМА-ТЕРАПІЇ ТА НАРАТИВНОЇ ПСИХОТЕРАПІЇ

The article compares schema-therapy to narrative therapy across three domains: (i) theoretical methodological and philosophical framework; (ii) technics (both methods and their theoretical background), and (iii) mechanisms of change in therapy. Several ways of integrating these two therapies are proposed. Schema therapy and narrative psychotherapy are based on contradicting methodologies of structuralism and post-structuralism. Schema therapy develops the concept of schemes, introduced by A. Beck, adding emotions, physiological reactions and memories to its structure, and stresses the importance of using emotion-focused techniques to change them. Narrative psychotherapy is based on theories of dialogical self, introduced by H. Hermans and narrative theories of identity, introduced by T. Sarbin and D. Bruner. Both methods use the idea of multimodal structure of personality. Schema therapy partly uses the idea of distancing from and observing modes, introduced by the third wave of cognitive-behavioral therapies. Narrative psychotherapy uses externalization of symptoms as one of the core techniques. Both methods modify the narrative of the person. Narrative psychotherapy seeks unique events to develop a new narrative of the person according to their values. Schema therapy uses imagery rescripting to meet the needs of a child mode and change emotions experienced in traumatic memory. Both therapies also use internalization of attachment figures. Schema therapy can integrate metaphors from narrative therapy to deal with personality modes. It also can be enriched by treating these modes as sub personalities of narrative psychotherapy and focusing on their narratives and values.

Hope, optimism, self-efficacy, and posttraumatic stress disorder: A meta-analytic review of the protective effects of positive expectancies.

The present meta-analysis consolidated research examining how positive expectancies (e.g., hope, self-efficacy, and optimism) may protect against the development of posttraumatic stress disorder (PTSD). Articles were identified by searching PILOTS, PsycINFO, PubMed, and ProQuest Dissertations and Theses databases. Aggregated results from 154 studies indicated that positive expectancies were associated with lower levels of PTSD symptoms. This relationship was stronger for coping-specific self-efficacy (k = 38, r = -.49; -.54 to -.43) and hope (k = 20, r = -.34; -.39 to -.28) compared with general self-efficacy (k = 45, r = -.25; -.30 to -.20) and optimism (k = 59, r = -.29; -.33 to -.25) when examining cross-sectional studies, and results were consistent in prospective studies. Age and gender did not moderate the cross-sectional relationships. These findings indicate that positive expectancies predict post-trauma resilience. Future research should identify moderators and examine positive expectancies as mechanisms of change in therapy.

Emotion regulation as a main mechanism of change in psychotherapy.

A model that suggests reconsolidation of traumatic memories as a mechanism of change in therapy is important, but problematic to generalize to disorders other than post-traumatic and acute-stress disorder. We suggest that a more plausible mechanism of change in psychotherapy is acquisition of adaptive emotion regulation strategies.

Functional Analytic Psychotherapy (FAP): A review of publications from 1990 to 2010.

Functional Analytic Psychotherapy (FAP), a model for psychotherapy based on radical behaviorism first developed by Kohlenberg and Tsai in 1991 (translated into Portuguese in 2001), proposes that the therapeutic relationship is the primary context for behavioral change in the therapeutic process for clients with interpersonal problems (Kohlenberg & Tsai, 2001; Kohlenberg, Tsai & Kanter, 2009). The authors suggest that everything the therapist needs and can use to help clients through the change process occurs during the session, in the therapeutic relationship. Specifically, FAP encourages the therapist to identify three classes of client clinically relevant behavior (CRB) occurring in session: CRB1, defined as behavioral problems occurring in session; CRB2, defined as behavioral improvements or progress in session, and CRB3, defined as the client's descriptions about the functional controlling variables of his behaviors (both inside and outside the session). FAP systematizes five rules around which the therapist should base treatment, including: (1) Observe the occurrence of CRBs, (2) Evoke CRBs, (3) Reinforce CRB2s, (4) Observe the reinforcing effects of therapist behavior on CRBs, and (5) Provide interpretations about the variables that affect client's behavior (Tsai et al, 2009). Since the FAP book appeared in 1991, many theoretical and empirical papers have appeared. These papers have been quite diverse. For example, several studies have been conducted to demonstrate how to use FAP combined with other interventions (Callaghan, Gregg, Marx, Kohlenberg, & Gifford, 2004; Gaynor & Lawrence, 2002; Kohlenberg, Kanter, Bolling, Parker, & Tsai, 2002). Follette and Callaghan (1995) and Callaghan (2006) discussed supervision in FAP, and described what they consider a more efficient way to conduct FAP supervision. Busch and col leagues (2008) performed an empirical micro-process analysis of FAP's mechanism of change. Oshiro (2011) also investigated the mechanism of change using interventions based on FAP, with an ABAB experimental design. Follette, Naugle and Callaghan (1996) presented important theoretical contributions to understand how FAP's therapeutic relationship can function as a mechanism of change in therapy. Callaghan, Summers and Weidman (2003) used FAP to treat a client with Histrionic and Narcissistic Personality Disorder. These examples demonstrate the diversity of writings on FAP that have appeared. Despite this diversity of publications, FAP has been criticized for producing too many theoretical articles making claims of FAP efficacy, without supportive empirical studies (Corrigan, 2001), and for not yet having conducted a randomized controlled trial to support FAP's efficacy (Ost, 2007). According to Ost (2007), there continues to be a lack of empirical data for the validation and wide acceptance of FAP as an efficacious intervention. A comprehensive review of papers on FAP has yet to be performed. In particular, previous reviews (e.g., Baruch et al., 2009; Corrigan, 2001; Ost, 2007) have been limited to only English-language publications, while we were aware of important publications on FAP in Portuguese coming out of Brazil, as well as in other languages. Thus, the current review made an effort to survey the global literature on FAP, not just English-language literature. Recently, Garcia (2008) included some Portuguese language publications in his review of FAP studies, which categorized FAP papers into six categories: integration with other therapies, supervision and improving therapeutic skills, methods for evaluation and data recording in therapy, studies of effectiveness and efficiency, experimental investigations into the relationship between thoughts and emotions, and application to clinical problems and new types of applications. In the current review, we expanded on the review by Garcia (2008) and conducted a comprehensive international search for FAP publications from 1990 to 2010. …

Changes in self-schema structure in cognitive therapy for major depressive disorder: A randomized clinical trial.

Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007; D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for treating the acute phase of a depressive episode and that this treatment also reduces the risk of relapse and recurrence, it is possible that CT may alter these stable cognitive structures. In the current study, patients were randomly assigned to CT+ pharmacotherapy (n = 21) or to pharmacotherapy alone (n = 21). Both groups evidenced significant and similar reductions in level of depression (as measured with the Beck Depression Inventory-II and the Hamilton Rating Scale for Depression), as well as automatic thoughts and dysfunctional attitudes. However, group differences were found on cognitive organization in favor of individuals who received the combination of CT+ pharmacotherapy. The implications of these results for understanding mechanisms of change in therapy and the prophylactic nature of CT are discussed.

Cognitive Therapy in Relationship

Cognitive Therapy in Relationship Interpersonal Process in Cognitive Therapy Safran, Jeremy D., & Segal, Zindel V. New York: Basic Books, Inc., 1990. (294 pp.) $27.95 (hardback). The authors begin by expressing their dissatisfaction with what they refer to as traditional, pure forms of cognitive therapy (CT). Although they never explicitly state what they mean by traditional CT, it is clear from their critique that it is Beck's CT of depression which is the primary sounding board for their call for revision. Safran and Segal indicate that their intention is not to offer a new school of psychotherapy, but rather to stimulate a process of conceptual and therapeutic expansion within cognitive-behavioral forms of psychotherapy. In fact, they are very critical of the purer, more traditional forms of CT for downplaying the importance of the therapeutic relationship in the change process. They assert that this imbalance has a "seriously detrimental impact on practice" (p. 4). To readdress this oversight, Safran and Segal strongly advocate the recent trend toward psychotherapy integration, especially the integration of cognitive and interpersonal approaches. Thus the authors draw from a variety of psychotherapy approaches including psychodynamic, gestalt, client-centered and of course schema-based cognitive therapies to offer a psychotherapy perspective that considers the therapeutic relationship the critical mediating variable for change. The book is divided into two major sections. The first four chapters provide a critique of traditional CT and a rationale for adopting a more interpersonal perspective to therapy. Chapter two, in particular, is devoted to a critical analysis of traditional CT. Safran and Segal assert that traditional CT: (1) tends to downplay the importance of the therapeutic relationship, (2) adopts a limited view of emotion, (3) ignores important interpersonal and social aspects of psychological distress and suffering, (4) defers the patient's construction of reality to the therapist's definition of what constitutes irrational or dysfunctional thinking, and (5) emphasizes the more structured and technical aspects of therapy instead of important process-oriented and relational factors. Chapter three discusses the psychotherapy process research indicating that the quality of the therapeutic alliance accounts for much of the change seen in psychotherapy outcome studies. This then leads into chapter four which describes Safran and Segal's cognitive interpersonal model of human change. The theoretical model proposed draws heavily from Harry Stack Sullivan's interpersonal theory, Bowlby's attachment theory, D.N. Stern's theory of the self, and the more recent affect theories which view emotions as specific action dispositions. The central construct of this ognitive interpersonal model is the interpersonal schema. According to the authors, the interpersonal schema contains representations of both the self and others, and thereby functions to maintain our relatedness to others. A dysfunctional interpersonal schema will lead to cognitive-interpersonal cycles that tend to alienate the patient from others. This cognitive-interpersonal model, then, provides the conceptual framework for the therapeutic approach advanced in the next seven chapters. Chapters six, seven and eight discuss the central tenets of cognitive interpersonal therapy. According to Safran and Segal there are three main mechanisms of change in therapy. Chapters six and seven describe the processes of decentering and experiential disconfirmation. A necessary but not sufficient step toward change involves patients experiencing their own role in the construction of reality, a process Safran and Segal call decentering. It is essential that the cognitive therapist explore with patients their thoughts and feelings so they become aware of how they construct reality. Disconfirmation, on the other hand, involves the challenging and modification of dysfunctional beliefs about the self and others. …