Psychotherapy Research Articles

Patient preferences for models of care for fibromyalgia: A discrete choice experiment.

Fibromyalgia is a common reason for referral to a rheumatologist and is a centralised pain state with symptoms beginning in adolescence/early adulthood and manifests as pain throughout the body, fatigue and cognitive dysfunction. Whilst there is considerable evidence on effective treatments, diagnosis and management are complex. There is almost no evidence on how to organise health services to deliver recommended therapies. The aim of the current study was to understand patient preferences for different features of healthcare services for fibromyalgia. We use the Discrete Choice Experiment Method (DCE), a choice-based survey that quantifies preferences for attributes of goods, services or policy interventions, to elicit preferences in relation to alternative models of care for people with fibromyalgia. In this study, attributes describe different models of care for fibromyalgia. We based attributes and levels on earlier phases of the PACFiND project and a literature review on fibromyalgia models of care. The final analysis sample consisted of 518 respondents who completed the survey in full. The final analysis sample consisted of 518 respondents ((patients living in the UK, over 18 years old, with a diagnosis of fibromyalgia), who completed the survey in full. The model of care most preferred is one characterised by earlier diagnosis and ongoing management by a Rheumatologist, via Face-to-face or Phone/video call appointments, with a stronger preference for the latter mode of support. The most preferred treatment was Medication, followed by Physical Therapy, with the least preferred being Talking Therapy. Relative to a Waiting Time for treatment of 6 months, respondents would prefer a lower Waiting Time of 3 months and dislike waiting 12 months for treatment. Respondents showed willingness to receive Ongoing Help and Advice by a Nurse Practitioner or a GP, instead of a Specialist Rheumatologist, provided they were compensated by other changes in the model of care. This study has found that, although respondents express a preference for specialist care, provided by a Rheumatologist, they may be willing to trade-off this preference against other features within a model of care. This willingness to accept a different skill-mix (e.g., appointments with a GP or a Nurse Practitioner) has important implications for practice and policy, as this is a more feasible option in settings where the availability of specialist care is highly constrained.

“Close to the Problem” or “Close to Your Problem”? The Contribution of Bond to the Structure of Early and Advanced Therapeutic Alliance

The study analyzed the contribution of bond in the structure of the therapeutic alliance. Results were reported for two stages of the psychotherapeutic process: early and advanced. The study included 415 psychotherapist–patient dyads in the process of individual psychotherapy. Alliance estimation was based on Bordin’s model of alliance. The hypothesis was tested through structural equation modeling analysis. In both the early and advanced phases of psychotherapy, patient–therapist bond made a large contribution to the structure of the alliance, similar to that of the remaining two components: goals and tasks. The results indicate that bond is a crucial and permanent element in the structure of the relationship in the psychotherapeutic dyad, regardless of the stage of the process. In the advanced phase, the distance in weight between bond and the remaining two dimensions of alliance is minimal. The contribution of bond to the alliance structure as high as the contributions of goals and tasks signals not only the importance of understanding the patient’s problem but also the importance of mutual trust and respect.

A Culturally Adapted Perioperative Mental Health Intervention for Older Black Surgical Patients

ObjectivesPerioperative mental health of older Black surgical patients is associated with poor surgical outcomes; however, evidence-based perioperative interventions are lacking. Our two study objectives included: first, examine factors affecting perioperative care experiences of older Black surgical patients with mental health problems, and second, ascertain design and implementation requirements for a culturally-adapted perioperative mental health intervention. Design Setting and ParticipantsWe conducted six focus groups with older Black patients (n = 15; ≥50 years; surgery within the past 5 years and/or interest in mental health research; history of distress, anxiety, or depression coping with surgery/hospitalization/) from a large academic medical center. We engaged study partners, including interventionists and community members, to gather insights on intervention and implementation needs. We followed a hybrid inductive-deductive thematic approach using open coding and the National Institute on Minority Health and Health Disparities Research Framework. ResultsPatients reported that their psychological well-being and long-term mental health outcomes were not appropriately considered during perioperative care. Perceived stressors included interpersonal and structural barriers to using mental healthcare services, clinician treatment biases and ageism in care, and lack of healthcare professional connections/resources. Patients utilized various coping strategies, including talk therapy, faith/spirituality, and family and friends. ConclusionThis study offers valuable insights into the experiences of older Black surgical patients and the critical elements for developing a personalized perioperative mental health intervention to support their well-being before, during, and after surgery. Our findings demonstrated a need for a patient-centered and culturally adapted intervention targeting the individual/behavioral and interpersonal levels. Informed by the cultural adaptation framework, we propose a multi-component intervention that integrates psychological and pharmacological components.

GPs' views of prescribing beta- blockers for people with anxiety disorders: a qualitative study.

Between 2003 and 2018, incident prescriptions of beta-blockers for anxiety increased substantially, particularly for young adults. National Institute for Health and Care Excellence guidance for anxiety does not recommend beta-blockers, probably due to a lack of evidence to support such use. Recent reports have highlighted the potential risks of beta-blockers. To understand when and why GPs prescribe beta-blockers for people with anxiety. In-depth interviews with 17 GPs in Bristol and the surrounding areas. Interviews were held by telephone or video call. A topic guide was used to ensure consistency across interviews. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Many GPs viewed beta-blockers as 'low risk', particularly for young adults. Some GPs viewed beta-blockers as an alternative to benzodiazepines, acting quickly and not leading to dependence. GPs reflected that some patients appeared to want an 'immediate fix' to their symptoms, which GPs thought beta-blockers could potentially offer. This is salient in light of substantial waiting lists for talking therapies and delays in antidepressants taking effect. GPs described how some patients seemed more willing to try beta-blockers than antidepressants, as patients did not perceive them as 'mental health drugs' and therefore viewed them as potentially more acceptable and less stigmatising. Further, GPs viewed beta-blockers as 'patient-led', with patients managing their own dose and frequency, without GP input. Many GPs believe that beta-blockers have a role to play in the management of anxiety. Given recent increases in the prescribing of these drugs in primary care, there is a need to assess their safety and effectiveness as a treatment for people with anxiety disorders.

Level of insight in Egyptian patients having obsessive compulsive disorder: a comparative study

Background and objectivesObsessive–compulsive disorder (OCD) is a chronic psychiatric disorder defined by the existence of obsessions and/or compulsive behaviors or mental acts persistently and affects around 1–3% of the population in the world. Multiple studies demonstrated the link of the insight level to how severe was OCD and existence of resistance to both medications and psychotherapy in individuals with OCD. Studying the characteristics associated with poor insight is very important for management of treatment-resistant OCD and development of new therapeutic approaches. The purpose of this work was to assess the level of the insight in Egyptian patients with OCD, identify clinical correlates that could anticipate the degree of insight, and assess the validity and reliability of brown assessment of belief scale after being translated to Arabic version.MethodsA comparative cross-sectional study of 96 individuals (male and female aged from 18 to 60) diagnosed with OCD based on the Arabic version of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). The study excluded any individuals with any coexisting neuro-psychiatric conditions and a history of major medical disease. Severity of OCD was assessed through the Arabic version of the Yale–Brown Obsessive–Compulsive Scale (YBOCS). Subsequently, participants performed the Brown Assessment of Beliefs Scale (BABS) after being translated into Arabic and assessed for reliability, validity and applicability of the translated form.ResultsPatients with OCD presented with poor insight were associated with more untreated time interval, longer disease duration and more severity that was dramatically differed (p ≤ 0.05, ≤ 0.001, ≤ 0.05 respectively). Also, there was a substantial notable correlation among BABS and YBOCS obsession, compulsion, and total score.ConclusionsThe existence of good insight in patients diagnosed with OCD was associated with lower severity and less duration of illness compared to patients with poor insight. Also, the more time waited before the intervention the worst the patient scores on the insight scale.

Retrospective evaluation of the Complementary Health and Wellbeing (CHW) service delivered at the Christie NHS trust UK.

IntroductionThe Complementary Health and Wellbeing service has been offering integrative therapies to cancer patients at The Christie Hospital NHS Trust since 1997 and has not undergone an external service evaluation in that time. It is considered a pioneering service. MethodAn external academic was invited to undertake a service evaluation based on information and experiences since the implementation of services changes as the result of the COVID 19 pandemic. Service users and therapists were interviewed along with review of quality control data and documentation. ResultsEighteen staff and eight patients were interviewed showing a high functioning and valuable service, offering a range of services to meet the needs of both inoutpatient and outpatient services. All staff are qualified and passionate, with a significant number of research outputs. However, the service is at capacity, and must rethink some delivery to ensure long term sustainability. Services offered include acupuncture, aromatherapy, massage, talking therapies and motivational behavioural changes. There is a high degree of patient satisfaction as the therapies help them manage their life affecting side effects, however accessing or being aware of the service before treatment commenced was a concern for patients. DiscussionThe Complementary Health and Wellbeing Service is well resourced, with all staff paid employees of the NHS trust funded via a charitable part of the trust. There is a self-funding education unit to provide staff training with participants coming from around the world. The therapists are expert practitioners who have undergone specialist training to work in this unique environment, however capacity to meet the needs of the service is limited, and there are gaps in the way patient evaluations are collected, which needs to be addressed for long term viability and future benchmarking. The changes to service to adapt to COVID-19 have become embedded within the service.

Therapeutic relationship elements and therapy session outcomes: Protocol for a longitudinal study of the patient's perspective.

There is a growing recognition of the key role of the therapeutic relationship in the outcomes of psychotherapy. However, current understanding of its specific components, their interplay and related patient-therapist dynamics is limited. (a) To validate two self-report measures to assess subjective affective reactions of patients toward their psychotherapists during specific therapy sessions, and (b) to explore the relationships and dynamics among four elements of the therapeutic relationship: patient reactions toward the therapist, working alliance, alliance ruptures and repairs, and the real relationship. This study uses a nonrandomized, two-time point longitudinal design. The target population is adult patients currently engaged in individual psychotherapy for heterogeneous mental conditions. Participants are recruited through two online recruitment platforms: Research for Me and ResearchMatch. Data collection involves administering two surveys through the Qualtrics online survey platform. The baseline survey assesses information about the most recent therapy session and the preceding week, while the follow-up survey collects data on the subsequent therapy session and the days leading up to it. This research offers three main contributions: (a) it furthers evidence-based assessment in psychotherapy by creating and validating two novel, succinct self-report tools; (b) it enhances theoretical understanding within therapeutic relationship research by exploring the significant impact of patients' perceptions of relationship elements on session outcomes variability; and (c) it will identify therapeutic relationship elements that can either enhance or hinder the overall relationship quality and session outcomes. The study protocol was approved by the Institutional Review Board of the University of North Carolina at Chapel Hill. The results will be published in indexed peer-reviewed journals and presented at relevant psychology and psychiatry conferences.

Equine-Assisted Therapy Pilot Program: A Post-Participation Study of Client Satisfaction

Equine-assisted therapy (EAT) is an emerging practice area that has been shown to decrease negative symptoms in individuals experiencing post-traumatic stress disorder (PTSD). While the research for equine-assisted therapy demonstrates effectiveness in decreasing PTSD symptoms, there is a lack of evidence to verify client satisfaction. The purpose of this mixed-methods study was to evaluate participant satisfaction using the eight-question “Client Satisfaction Survey” and compose recommendations based on participant feedback from a focus group after completing an Equine-Assisted Therapy Post-traumatic stress disorder (EAT-PTSD) program. Two participants attended an EAT-PTSD program that utilized the protocol developed by the Man O’ War project. Both participants attended all sessions and completed pre- and post-measures including the Post-Traumatic Stress Disorder Checklist Criterion Assessment, the 16-item Quick Inventory of Depressive Symptomatology Self-Report, informal numerical anxiety ratings, and a focus group for evaluation of program satisfaction and future recommendations. The results show that completion of an EAT-PTSD program decreases negative PTSD symptoms. Additionally, participants had an overall high satisfaction rate after completion of an EAT-PTSD program. Recommendations from program participants for future program delivery include increasing program length, using additional resources like talk and group therapy, and recruiting more participants to take part in the program.

Treating Narcissistic Disorders in General Psychiatry: Practical Application of Transference-Focused Psychotherapy Principles.

Patients with primary or co-occurring narcissistic disorders are seen routinely in general psychiatry settings. Contemporary trends in training and practice have impacted psychiatrists' skills and confidence in identifying and treating these disorders, which can range from relatively benign to high-acuity presentations. The goal of this article is to introduce key principles derived from transference-focused psychotherapy (TFP) for use by clinicians in general practice in their work with patients with narcissistic disorders, even when those clinicians do not routinely provide individual psychotherapy. Practical application of TFP principles in work with patients with narcissistic disorders in general psychiatry are proposed, including in diagnostic evaluation, family engagement, prescribing, and safety assessment and risk management calculus. Many psychiatrists whose practices are focused primarily on psychopharmacology, or a "medical model," may not appreciate fully the impact of pathological narcissism in their work. Clinicians who may benefit from familiarity with TFP principles in work with patients with narcissistic disorders include the approximately one-half of U.S. psychiatrists who do not offer psychotherapy in their practice.

Empowering Minds, Easing Pain: The Role of Talk Therapy in Sickle Cell Disease

Empowering Minds, Easing Pain: The Role of Talk Therapy in Sickle Cell Disease

The Promise of MDMA in the Future Treatment of Severe Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is an often debilitating condition caused by a person’s exposure to traumatic events. Symptoms of PTSD include intrusive thoughts, suicidal ideation, and highly negative and distressing emotional states. Current treatments for PTSD such as cognitive behavioral therapy, EMDR, and SSRIs and SNRIs are ineffective for a large chunk of patients who seek out treatment. A majority of patients with PTSD do not respond to talking therapy, and the remission rate for patients on SSRIs and SNRIs is low. The ineffectiveness of recommended treatments has led to experimentation with drugs like MDMA. MDMA increases levels of chemicals in the brain that induce happy and calm states. This drug also decreases fear states in patients, allowing them to more comfortably discuss traumatic events without the possible side effects of extreme emotional numbness or high levels of anxiety. Research conducted in the last decade on MDMA in addition to psychotherapy in a clinical setting has yielded impressive results. A majority of patients in all three conducted trials experienced a long-term reduction in PTSD symptoms. MDMA in a clinical setting was also proven to be safe, with no serious drug-related side effects on patients. With such high rates of symptom reduction, these studies provide hope for the future of effective and safe PTSD treatment.

How Does Individual Psychotherapy Promote Recovery for Persons with Psychosis? A Systematic Review of Qualitative Studies to Understand the Patient's Experience.

Psychotherapy for individuals with psychosis is an effective treatment that promotes recovery in various ways. While there is strong quantitative evidence across modalities, less is known from the patient's perspective. There are many varied forms of psychotherapy, and gaining the patient's perspective can improve understanding of salient elements of psychotherapy and increase engagement, ultimately improving recovery rates. The purpose of this review is to identify and integrate data from published studies of patient perspectives of psychotherapy for psychosis to understand essential elements across approaches, differences between approaches, and how psychotherapy impacts recovery. We aimed to understand further: what are the perceptions about individual psychotherapy from the perspective of individuals with psychosis? The current study was a systematic review using PRISMA guidelines of studies that included qualitative interviews with persons with experiences of psychosis who participated in psychotherapy. All three authors participated in the literature search using Pubmed, APA PsycInfo, and Psychiatry Online. We identified N = 33 studies. Studies included cognitive therapies, acceptance and mindfulness approaches, trauma therapies, metacognitive therapy, and music therapy. All studies reported participants' perceived benefit with the therapeutic relationship as especially salient. Participants described diverse aspects of objective (e.g., symptoms, functioning) and subjective (e.g., self-experience or quality of life) recovery improvements, with perceived mechanisms of change, and with music therapy having some unique benefits. Participants also reported challenges and suggestions for improvement. Study findings highlight the salient aspects of psychotherapy identified by patients that may help therapists to individualize and improve approaches to psychotherapy when working with individuals experiencing psychosis. Overall, findings support the potential for integrative psychotherapy approaches for maximal treatment personalization.

What Good Are Treatment Effects Without Treatment? Mental Health and the Reluctance to Use Talk Therapy

What Good Are Treatment Effects Without Treatment? Mental Health and the Reluctance to Use Talk Therapy

Characteristics and Effectiveness of Individual Psychotherapy for Palliative and End-of-Life Care: A Literature Review for Randomized Controlled Trials.

The introduction of psychotherapy in palliative and end-of-life care settings has become increasingly common and is effective in decreasing many psychological problems. This review reports the characteristics and effectiveness of individual psychotherapeutic interventions for patients receiving palliative and end-of-life care. In addition, the review reports the effectiveness of psychotherapies considering the expected life expectancy. The PubMed, Google Scholar, and Cochrane Library databases were searched for English-language articles published between January 2000 to May 2023. Twenty-six studies were included and classified into a total of nine types of psychotherapies, namely, dignity therapy (DT), life review therapy, narrative therapy, managing cancer and living meaningfully (CALM), individual meaning-centered psychotherapy, meaning and purpose therapy, meaning-making therapy, meaning-of-life therapy, and cognitive therapy. Most of the psychotherapies provided to patients receiving palliative and end-of-life care showed effectiveness in the reduction of negative emotions and positive factors related to end-of-life issues. Most studies targeted patients with advanced cancer; however, studies on DT did not limit the target group to patients with cancer. Considering the expected life expectancy, CALM was found to be suitable for patients receiving early palliative care.

Norwegian general practitioners’ perceptions of their depression care – a national survey

BackgroundThe General Practitioner (GP) is often the first professional contact for patients with depression. Depression care constitutes a substantial part of GPs’ workload.ObjectiveTo assess how GPs experience their patients’ expectations and their own provision of depression care; further, how their depression care was associated with doctor- and practice-characteristics.MethodsA cross-sectional questionnaire study about depression care in general practice among the GPs in the Norwegian Physician Survey of 2021.ResultsOf the 221 responding GPs, 50% were female and 70% agreed to have constant time pressure due to workload. The GPs believed that patients with depression were interested in their professional assessment (87.2%) and saw them as providers of talking therapy (76,9%). Still, 77,8% of the GPs thought the patients expected a referral. Talking therapy was commonly provided (79.6%) along with consultations of more than 30 min (80.4%). The youngest age group and GPs with shorter patient lists spent more time. Most GPs (92.3%) considered their help to be of great benefit for depressed patients. However, one-fourth of the GPs did not feel competent in providing talking therapy, less frequently reported by the GPs aged 40–54 years.ConclusionsTalking therapy is commonly provided by GPs. However, there is a need to investigate what GP talking therapy implies, and to strengthen GP skills in this regard. Overall, the GPs experience their depression care to be useful for their patients, and do not de-prioritize this although they experience workload pressure.

Psychotherapy to emphasize self-directed recovery for persons with serious mental illness: Contributions from metacognitive reflection and insight therapy (MERIT).

Recovery from serious mental illness (SMI) is a complex process that can be supported by different levels of mental health care, for example, individual psychotherapy. Current individual evidence-based psychotherapy for persons with SMI is often focused on specific objective recovery outcomes, including symptom reduction and functional improvement, and requires a minimum level of insight. Less common but also important are broader, more flexible approaches that allow clients to explore their needs and challenges, without predetermined goals or a certain level of insight. The current article aims to describe (1) the development of metacognitive reflection and insight therapy (MERIT), an evidence-based psychotherapy that is focused on self-determination, or self-directed recovery, and (2) how MERIT advances care for persons with SMI by addressing a significant gap in the field for the treatment of people with SMI with limited metacognitive capacity and insight, offering an adaptable approach emphasizing self-directed recovery. MERIT utilizes a metacognitive framework that is guided by flexible key elements and an interpersonal environment. Training MERIT therapists early in their careers may be helpful in providing a holistic view of SMI to promote self-directed recovery in ways that are personalized and meaningful for each person. MERIT training has been completed in multiple countries across different levels of training (e.g., internship and psychology practicum). Professionals such as psychologists and social workers have effectively played a role in MERIT development and dissemination, which ultimately strives to advance psychotherapy for a wide range of individuals with SMI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

La Fantasía de las Terapias Conversacionales del NHS en Reino Unido

In February 2023, the English program "Improving Access to Psychological Therapies" (IAPT) was rebranded as "NHS Talking Therapies", although this change did not translate into substantial improvements indicating an advancement in service quality. The primary purpose of this article is to critically assess the myths perpetuated by the IAPT (now NHS Talking Therapies). Despite the striking marketing campaign of NHS Talking Therapies, it does not appear to have succeeded in reducing the burden of mental health in the United Kingdom. The service has claimed to be merely a conduit for providing protocols endorsed by the National Institute for Health and Care Excellence. IAPT is sustained through a series of myths that are refuted and extensively discussed. Without using criteria to determine whether a psychological treatment is empirically supported, countries are likely to fall prey to well-marketed pharmacological or psychological interventions. Furthermore, without such controls, service providers are licensed to squander money, sidelining the needs of the population.

Education and training of telemental health providers: a systematic review.

To conduct a systematic literature review of education and training (E&T) programs for telemental health (TMH) providers in the past 10 years to qualitatively clarify field offerings and methodologies, as well as identify areas for future growth. We searched five major electronic databases: PubMed, PsycINFO, Scopus, CINAHL, and Web of Science for original publications on TMH E&T from January 2013 to May 2023. We extracted information from each publication and summarized key features of training programs including setting, target group, study aims, training modality, methods of assessing quality, and outcomes. A total of 20 articles were selected for the final review. Articles meeting inclusionary criteria were predominantly comprised of case studies and commentaries, focused on a TMH service/practice for a specific region/population, and were performed after 2020. All of the selected studies demonstrated a significant increase in the measured knowledge, skills, and abilities of the participants after TMH training. Nevertheless, there remains a lack of standardization of training methodologies, limited sample sizes and demographics, variability in study methodologies, and inconsistency of competency targets across studies. This systematic review highlighted the diversity of methods for TMH E&T. Future research on this topic could include more varied and larger-scale studies to further validate and extend current findings, as well as explore potential long-term effects of TMH training programs on both provider attitudes and patient outcomes.

Data-Driven Exploration of National Health Service Talking Therapies Care Pathways Using Process Mining: Retrospective Cohort Study.

The National Health Service (NHS) Talking Therapies program treats people with common mental health problems in England according to "stepped care," in which lower-intensity interventions are offered in the first instance, where clinically appropriate. Limited resources and pressure to achieve service standards mean that program providers are exploring all opportunities to evaluate and improve the flow of patients through their service. Existing research has found variation in clinical performance and stepped care implementation across sites and has identified associations between service delivery and patient outcomes. Process mining offers a data-driven approach to analyzing and evaluating health care processes and systems, enabling comparison of presumed models of service delivery and their actual implementation in practice. The value and utility of applying process mining to NHS Talking Therapies data for the analysis of care pathways have not been studied. A better understanding of systems of service delivery will support improvements and planned program expansion. Therefore, this study aims to demonstrate the value and utility of applying process mining to NHS Talking Therapies care pathways using electronic health records. Routine collection of a wide variety of data regarding activity and patient outcomes underpins the Talking Therapies program. In our study, anonymized individual patient referral records from two sites over a 2-year period were analyzed using process mining to visualize the care pathway process by mapping the care pathway and identifying common pathway routes. Process mining enabled the identification and visualization of patient flows directly from routinely collected data. These visualizations illustrated waiting periods and identified potential bottlenecks, such as the wait for higher-intensity cognitive behavioral therapy (CBT) at site 1. Furthermore, we observed that patients discharged from treatment waiting lists appeared to experience longer wait durations than those who started treatment. Process mining allowed analysis of treatment pathways, showing that patients commonly experienced treatment routes that involved either low- or high-intensity interventions alone. Of the most common routes, >5 times as many patients experienced direct access to high-intensity treatment rather than stepped care. Overall, 3.32% (site 1: 1507/45,401) and 4.19% (site 2: 527/12,590) of all patients experienced stepped care. Our findings demonstrate how process mining can be applied to Talking Therapies care pathways to evaluate pathway performance, explore relationships among performance issues, and highlight systemic issues, such as stepped care being relatively uncommon within a stepped care system. Integration of process mining capability into routine monitoring will enable NHS Talking Therapies service stakeholders to explore such issues from a process perspective. These insights will provide value to services by identifying areas for service improvement, providing evidence for capacity planning decisions, and facilitating better quality analysis into how health systems can affect patient outcomes.

Client preferences, therapy activities and preference-activity match as predictors of therapy outcome

ABSTRACT Objective: This study investigated whether distinct types of psychotherapy activities, the client’s preference towards these activities prior to therapy, and the degree of match between client preferences and therapy activities, served as predictors of treatment outcomes. Methods: A total of 621 clients (M age = 42 years, 71.7% female) received individual psychotherapy by 54 psychologists. Associations between activity preferences, therapy activities, and preference-activity match as predictors, and symptom change and treatment dropout as outcomes were analyzed using multilevel longitudinal and logistic modelling and polynomial regression models with response surface analysis. Results: No type of therapy activity or activity preference significantly predicted symptom change in therapy, while higher levels of inward orientation therapy activities predicted an increased risk of dropout. Moreover, matching and higher levels of inward orientation and affect expression activities predicted an increased risk of dropout, and matching and higher levels of outward orientation activities predicted a decreased risk of dropout. Finally, a preference-activity mismatch in affect suppression predicted an increased risk of dropout from therapy, both at higher and lower levels of affect suppression. Conclusion: Distinct types of therapy activity preferences may, especially when (mis)matched with similar levels of the same therapy activities, differentially predict particular dropout from therapy. Trial registration: ClinicalTrials.gov identifier: NCT05630560.