Psychotherapy For Patients Research Articles

Enhancing Predictive Power: Integrating a Linear Support Vector Classifier with Logistic Regression for Patient Outcome Prognosis in Virtual Reality Therapy for Treatment-Resistant Schizophrenia.

(1) Background: Approximately 30% of schizophrenia patients are known to be treatment-resistant. For these cases, more personalized approaches must be developed. Virtual reality therapeutic approaches such as avatar therapy (AT) are currently undergoing investigations to address these patients' needs. To further tailor the therapeutic trajectory of patients presenting with this complex presentation of schizophrenia, quantitative insight about the therapeutic process is warranted. The aim of the study is to combine a classification model with a regression model with the aim of predicting the therapeutic outcomes of patients based on the interactions taking place during their first immersive session of virtual reality therapy. (2) Methods: A combination of a Linear Support Vector Classifier and logistic regression was conducted over a dataset comprising 162 verbatims of the immersive sessions of 18 patients who previously underwent AT. As a testing dataset, 17 participants, unknown to the dataset, had their first immersive session presented to the combinatory model to predict their clinical outcome. (3) Results: The model accurately predicted the clinical outcome for 15 out of the 17 participants. Classification of the therapeutic interactions achieved an accuracy of 63%. (4) Conclusion: To our knowledge, this is the first attempt to predict the outcome of psychotherapy patients based on the content of their interactions with their therapist. These results are important as they open the door to personalization of psychotherapy based on quantitative information about the interactions taking place during AT.

How can resilience be described in a process-oriented view and does this have significance for psychotherapy? A qualitative study

Objectives: Despite its high appeal, the concept of resilience remains unclear. Current definitions include a process approach, but most resilience scales remain trait-based. This study assessed implicit concepts of researchers in an interdisciplinary research group in order to develop a process-based model of resilience. Methods: Expert interviews were conducted with nine experienced researchers from the fields of theology, medicine, and philosophy and analyzed using qualitative content analysis. Results: Categories are classified as predictive, process-related or outcome-related. Central elements in the process are the articulation and acceptance of negative experiences as well as a narrativization and meaningful integration of experiences. Conclusions: Based on the categories, a working definition for a process-oriented resilience model is created.The categories show proximity to known elements and goals of psychotherapy. The reinterpretation of resilience as a process of conscious "moving forward" (Yahuda) instead of an unattainable "hero ideal" can be helpful for psychotherapy patients.

Early distress score instability predicts outcome in brief psychotherapy.

Among psychotherapy patients, unstable early distress scores are known to predict substantial intersession improvement later in treatment. The evidence has been ambiguous as to whether early distress instability also predicts outcome. We investigated the links among early distress instability, later intersession improvement, and outcome. In a sample of 1,796 students treated with brief psychotherapy at university counseling centers, we sought to predict intersession improvement and treatment outcome from an index of distress instability, as assessed during the first four treatment sessions. Large intersession shifts late in treatment appeared to mediate the link between early distress instability and outcome. These relationships were limited to participants who demonstrated early score shifts larger than measurement error. As hypothesized by dynamic systems theory, some psychotherapy patients experience stepwise improvement that is preceded by early instability in distress scores. However, the effect size linking early instability to outcome is small. Sudden gains may not be the optimal measure to elucidate these relationships. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Patient-Perceived Helpfulness of Measures Scale: Development and Validation of a Scale to Assess the Helpfulness of Using Measures in Psychological Treatment.

In response to the increase in Routine Outcome Monitoring and Clinical Feedback, the Patient-Perceived Helpfulness of Measures Scale (ppHMS) was developed to assess the helpfulness-as perceived by patients-of using measures in psychological treatment. Study 1: The construct of patient-perceived helpfulness of measures was explored using thematic analysis with 15 patients. Six helpful and three unhelpful themes were identified and informed item development. Study 2: 28 items were formulated and rated by experts. Ten items were taken forward for psychometric shortening in a sample of 76 patients. Confirmatory factor analysis (CFA) led to an adequately fitting six-item model with excellent internal consistency, and convergence with the Delighted-Terrible single item of product satisfaction and a single item of measure helpfulness. Study 3: In a stratified online sample of 514 U.K. psychotherapy patients, a five-item model constituted the best fit. The final ppHMS had excellent internal consistency (McDonald's ω = .90), convergent validity with psychotherapy satisfaction (r = .5; p < .001), divergence from social desirability (r = .1), and metric and scalar invariance across measures. Study 4: Analyses were replicated and confirmed in a stratified U.S. sample (n = 602). The ppHMS is a reliable and valid scale that can be used to assess and compare patients' perceptions of the helpfulness of different measures as part of their psychological treatment.

Symptom Change during Waitlist for Medicated and Nonmedicated Patients with Chronic Depression

Introduction: Patients seeking psychotherapy often spend time on waitlist (WL), the effect of which is largely unknown. WL patients may forego alternative non-psychotherapeutic assistance and thus do more poorly than had they not been placed on a WL. The course of symptoms might also be influenced by use of antidepressant medication (ADM), an issue that remains unexplored in the literature. Objective: In a naturalistic setting, WL symptom change before inpatient psychotherapy (mean weeks of waiting = 22.6) was assessed in a sample (N = 313) of chronically depressed patients. Methods: Using the Beck Depression Inventory-II, patients’ symptoms were tracked at assessment, when admitted to treatment (i.e., after WL), at posttreatment and 1-year follow-up. Multilevel growth curve analysis was used to examine waitlist change for the whole sample as well as for ADM users and nonmedicated patients. Results: Symptoms were reduced significantly from assessment to admittance (Cohen’s d = 0.47). Symptoms reduced less for ADM users (d = 0.39) than for nonmedicated patients (d = 0.65). Conclusion: The findings indicate that chronically depressed patients experience a decrease in symptoms during WL, quite likely due to treatment expectations. We discuss whether less symptom improvement for ADM users could be attributed to iatrogenic comorbidity and a higher degree of demoralization in this group.

A systematic review of the association between interpretations and immediate, intermediate, and distal outcomes.

Interpretations are a hallmark of psychodynamic treatment and a method used in other theoretical orientations as well. Therapists use interpretations to increase patients' insight concerning unconscious and preconscious elements in their lives, with the ultimate aim to reduce mental pain and suffering and improve mental health. This systematic review focuses on the association between the therapists' use and accuracy of interpretation and immediate (within-session), intermediate (between-session), and distal (end-of-treatment) outcomes. This synthesis of the research literature is based on 18 independent samples of 1,011 total patients in individual psychotherapy. The results suggest that the use and accuracy of interpretations were associated, in half the studies, with patient disclosure of emotions and increased insight at the immediate, moment-to-moment enfolding of the session. At the intermediate postsession outcome, the use of interpretations was associated with a stronger alliance and greater depth, in half the studies. At the end of treatment, however, while there is some evidence for a positive effect of the use of interpretations on treatment success, there are also neutral effects and even evidence that interpretations have the potential to be harmful in some particular situations. The article concludes with training implications and therapeutic practices based on the integration of clinical experience and research evidence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A meta-analysis of the effects of role induction in psychotherapy.

Role induction is a pantheoretical method that can be used in the initial phase of psychotherapy to prepare patients for treatment. The purpose of this meta-analysis was to examine the effects of role induction on treatment dropout, and immediate, mid-, and posttreatment outcomes for adult individual psychotherapy patients. A total of 17 studies were identified that met all inclusion criteria. Data from these studies indicate that role induction has a positive impact on reducing premature termination (k = 15, OR = 1.64, p = .03, I² = 56.39) and improving immediate within-session outcomes (k = 8, d = 0.64, p < .01, I² = 88.80) and posttreatment outcomes (k = 8, d = 0.33, p < .01, I² = 39.89). However, role induction did not show a significant impact on midtreatment outcomes (k = 5, d = 0.26, p = .30, I² = 71.03). Results from moderator analyses are also presented. Training implications and therapeutic practices based on this research are also discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Feedback About a Person’s Social Context - Personal Networks and Daily Social Interactions

The social context of a person, meaning their social relationships and daily social interactions, is an important factor for understanding their mental health. However, personalised feedback approaches to psychotherapy do not consider this factor sufficiently yet. Therefore, we developed an interactive feedback prototype focusing specifically on a person’s social relationships as captured with personal social networks (PSN) and daily social interactions as captured with experience sampling methodology (ESM). We describe the development of the prototype as well as two evaluation studies: Semi-structured interviews with students (N = 23) and a focus group discussion with five psychotherapy patients. Participants from both studies considered the prototype useful. The students considered participation in our study, which included social context assessment via PSN and ESM as well as a feedback session, insightful. However, it remains unclear how much insight the feedback procedure generated for the students beyond the insights they already gained from the assessments. The focus group patients indicated that in a clinical context, (social context) feedback may be especially useful to generate insight for the clinician and facilitate collaboration between patient and clinician. Furthermore, it became clear that the current feedback prototype requires explanations by a researcher or trained clinician and cannot function as a stand-alone intervention. As such, we discuss our feedback prototype as a starting point for future research and clinical implementation.

Shame and Self-Alienation: A Trauma-Informed Psychoanalytic Perspective

ABSTRACT Self-alienation is an expression of deeply internalized shame. The self-alienated individual feels trapped, imprisoned by shame. Psychotherapy patients with significant relational trauma typically reveal a persistent internal battle against self-doubt, self-condemnation, and often self-loathing. They are referencing shameful fears and beliefs about themselves that are born from problematic attachment and developmental experiences. The author provides illustrations of work with self-alienated individuals integrating psychoanalytic principles with concepts from contemporary traumatology, with a focus on helping patients develop self-compassion as the chief agent of therapeutic healing and growth.

A network perspective on real-life threat, anxiety, and avoidance.

Anxiety, approach, and avoidance motivation crucially influence mental and physical health, especially when environments are stressful. The interplay between anxiety and behavioral motivation is modulated by multiple individual factors. This proof-of-concept study applies graph-theoretical network analysis to explore complex associations between self-reported trait anxiety, approach and avoidance motivation, situational anxiety, stress symptoms, perceived threat, perceived positive consequences of approach, and self-reported avoidance behavior in real-life threat situations. A total of 436 participants who were matched on age and gender (218 psychotherapy patients, 218 online-recruited nonpatients) completed an online survey assessing these factors in response to the COVID-19 pandemic. The resulting cross-sectional psychological network revealed a complex pattern with multiple positive (e.g., between trait anxiety, avoidance motivation, and avoidance behavior) and negative associations (e.g., between approach and avoidance motivation). The patient and online subsample networks did not differ significantly, however, descriptive differences may inform future research.

Central psychological symptoms from a network analysis of patients with anxiety, somatoform or personality disorders before psychotherapy

BackgroundCross-sectional network analysis examines the relationships between symptoms to explain how they constitute disorders. Up to now, research focuses mostly on depression, posttraumatic stress disorder, and rarely assesses larger networks of various symptoms measured with instruments independent of classifications. Studies on large groups of psychotherapy patients are also rare. MethodsAnalyzing triangulated maximally filtered graph (TMFG) networks of 62 psychological symptoms reported by 4616 consecutive nonpsychotic adults in 1980–2015. ResultsCase-dropping and nonparametric bootstrap proved the accuracy, stability and reliability of networks in patients' sex-, age-, and time of visit divided subgroups. Feeling that others are prejudiced against the patient was the most central symptom, followed by catastrophic fears, feeling inferior and underestimated. Sadness, panic, and sex-related complaints were less central than we expected. All analysed symptoms were connected, and we found only small sex-related differences between subsamples' networks. No differences were observed for time of visit and age of patients. LimitationAnalyses were cross-sectional and retrospective, not allowing examination of directionality or causality. Further, data are at the between-person level; thus, it is unknown whether the network remains constant for any person over time. One self-report checklist and building binary network method may bias results. Our results indicate how symptoms co-occured before psychotherapy, not longitudinally. Our sample included public university hospital patients, all White-Europeans, predominantly females and university students. ConclusionsHostile projection, catastrophic fears, feeling inferior and underestimated were the most important psychological phenomena reported before psychotherapy. Exploring these symptoms would possibly lead to enhancement of treatments.

Multidimensional Assessment of Strengths and Their Association With Mental Health in Psychotherapy Patients at the Beginning of Treatment.

Modern concepts assume that mental health is not just the absence of mental illness but is also characterized by positive well-being. Recent findings indicated a less pronounced distinction of positive and negative mental health dimensions in clinical samples. Self-perceived strengths were associated with markers of mental health in healthy individuals. However, analyses of strengths and their association with different mental health variables in clinical populations are scarce. A cross-sectional design was conducted at a German outpatient training and research center. 274 patients before treatment (female: 66.4%, mean age = 42.53, SD = 13.34, range = 18-79) filled out the Witten Strengths and Resource Form (WIRF), a multidimensional self-report of strengths, as well as other instruments assessing positive and negative mental health variables. Data was analyzed with structural equation modeling and latent regression analyses. Confirmatory factor analysis of the WIRF showed good model fit for the assumed three-subscale solution. Regarding mental health, a one-factor model with positive and negative variables as opposite poles showed acceptable fit. A correlated dual-factor model was not appropriate for the data. All WIRF subscales significantly predicted unique parts of variance of the latent mental illness factor (p = .035 - p < .001). The context-specific assessment of patients' strengths was confirmed and led to an information gain in the prediction of mental health. Results suggest that positive and negative facets of mental health are highly entwined in people with pronounced symptoms. The scientific and practical implications of these findings are discussed.

Trajectories of change among highly challenging patients in intensive long-term psychoanalytic psychotherapy.

This study aimed to identify and describe trajectories of change in distress among highly challenging patients who had received long and intensive psychoanalytic psychotherapy. The longitudinal version of the K-means algorithm was applied to the outcome measures data of 74 patients treated in four public mental health centers. The patients were measured five times at 6-month intervals for three outcome measures. For the OQ45 andSymptom Checklist-90, one trajectory was marked by a lower initial distress level. In this trajectory, the improvement occurred in the first half of the measurements, with a plateau thereafter. A second trajectory was characterized by higher initial severity and an improvement, mainly in the second part of the measurements. For the BeckDepression Inventory, one trajectory was marked by lower initial distress. In this group, the improvement occurred throughout the entire period. The remaining patients were characterized by higher initial distress and a decreased level of distress in the last part of treatment. They began to improve only during the third year of therapy. The response to treatment is not uniform in long-term treatment for highly challenging patients. A significant number of patients require a longer period of therapy to ignite improvement.

Evaluation of doctors’ experience of psychodynamic psychotherapy training at Leeds and York Partnership NHS Foundation Trust during the COVID‐19 pandemic

Developing psychotherapeutic competencies is an essential part of psychiatric training. All Core Trainees at Leeds and York Partnership NHS Foundation Trust (LYPFT) saw a patient for psychodynamic psychotherapy until 2020. Due to the pandemic, all face‐to‐face appointments at the LYPFT Medical Psychotherapy Service were paused from March 2020. Patients could choose whether to continue therapy remotely or defer therapy. Supervision was also moved to a remote format. Face‐to‐face therapy sessions resumed from August 2020, with new infection control procedures. This project aimed to establish doctors’ experience of training in delivering psychodynamic psychotherapy at LYPFT during the pandemic. A two‐step methodology was used: an online survey including qualitative and quantitative analysis of the impact of the pandemic; and semi‐structured interviews with thematic analysis. The online survey had a response rate of 68%. Four patients deferred therapy; the mean deferral length was two months. Ten respondents had sessions cancelled due to infection/self‐isolation. Thirteen respondents (commencing therapy pre‐pandemic) delivered therapy face‐to‐face (without personal protective equipment [PPE]). During the pandemic five respondents delivered therapy via phone, six face‐to‐face with PPE. Thirteen were concerned about attaining psychotherapy competencies. Thematic analysis of the interviews identified three main themes (with subthemes). Challenges of delivering therapy during the pandemic were identified, as well as areas of good practice and opportunities.

A Conceptual Framework for Preparing Residents to Broach Racial, Ethnic, and Cultural Factors with Patients in Supportive Psychotherapy.

A Conceptual Framework for Preparing Residents to Broach Racial, Ethnic, and Cultural Factors with Patients in Supportive Psychotherapy.

Ambivalent toward life, ambivalent toward psychotherapy? An investigation of the helping alliance, motivation for treatment, and control expectancies in patients with suicidal ideation in inpatient psychotherapy.

Research has found that patients with suicidal ideation (SI) are at high risk for unfavorable outcomes. The present work aimed to expand the knowledge about their characteristics and treatment success. Data were drawn from a routine assessment of N = 460 inpatients. We used patients' self-report data as well as therapists' reports covering baseline characteristics, depression and anxiety symptoms (at the start and end of therapy), psychosocial stress factors, helping alliance, treatment motivation, and treatment-related control expectancies. In addition to group comparisons, we conducted tests of associations with treatment outcome. SI was reported by 232 patients (50.4% of the sample). It co-occurred with higher symptom burden, more psychosocial stress factors, and negation of help. Patients reporting SI were more likely to be dissatisfied with the treatment outcome (although their therapists were not). SI was related to higher levels of anxiety symptoms after treatment. In regression models of depression and anxiety symptoms, interactions of SI with the external control expectancy powerful others were observed, suggesting that in patients with frequent SI, this control expectancy hindered recovery. Patients reporting SI are a vulnerable group. Therapists could support them by addressing (potentially conflicting) motivations and control expectancies.

Extended validation of the Relational Depth Frequency Scale: Retest reliability, divergent and criterion validity, and measurement invariance in UK- and US-stratified samples.

The Relational Depth Frequency Scale (RDFS) assesses moments of profound connection in psychotherapy, associated with therapeutic benefit. To date, the RDFS has not been tested for its retest reliability, divergent and criterion validity, and measurement invariance, nor has it been tested in stratified samples of psychotherapy patients. Two stratified online samples of United Kingdom (n = 514) and United States (n = 402) psychotherapy patients filled out the RDFS, the Brief Social Desirability Scale (BSDS); and the Satisfaction with Therapy and Therapist Scale-revised (STTS-R). Two subsamples of patients (United Kingdom: n = 50 and United States: n = 203) filled out the RDFS again after 1 month. Reliability for the six-item RDFS were excellent in United Kingdom and United States samples (Cronbach's α = 0.91 and 0.92; retest r = 0.73 and r = 0.76). Divergent (r = 0.10 and r = 0.12) and criterion validity (r = 0.69; and r = 0.70) were good. Full scalar invariance was established across countries, genders, and time. This contributes important evidence to the validity of the RDFS. Future research should assess predictive validity against psychotherapy outcomes and replicate these analyses in diverse samples.

The moderating effect of emotion regulation in the association between social support and religiosity and psychological distress in adults

BackgroundLebanese adults face daily obstacles due to their numerous responsibilities and non-ending external pressures to the extent that Lebanon has been ranked second among highest negative experiences countries worldwide. A sparse number of international studies showed that positive social support, religiosity and cognitive reappraisal would decrease psychological distress, but none in Lebanon. This study aimed to evaluate the association between social support, religiosity and psychological distress among Lebanese adults, taking into consideration the moderating role of emotion regulation.Methods387 adult participants enrolled in this cross-sectional study between May and July 2022. Participants were chosen from five different governorates in Lebanon, using the snowball sampling technique, and were asked to complete a structured questionnaire, which included the following scales: the Mature Religiosity Scale, the Emotional Regulation Scale, the Depression Anxiety Stress Scale, and the Multidimensional Scale of Perceived Social Support.ResultsThe interaction social support by cognitive reappraisal was significantly associated with psychological distress; at high levels of cognitive reappraisal and low levels of expressive suppression, higher social support (Beta = − 0.07; p = .007) was significantly associated with lower psychological distress. The same was found at high levels of cognitive reappraisal and moderate levels of expressive suppression (Beta = − 0.08; p = .021). Social support alone was not significantly associated with psychological distress in the model (Beta = 0.15; t = 1.04; p = .300; 95% CI − 0.14; 0.44).ConclusionThis cross-sectional study has provided evidence that the adequate use of emotional regulation skills such as high level of cognitive reappraisal and low level of expressive suppression with presence of social support would remarkably decrease psychological distress. This result casts a new light on clinical approaches to tackle this association between the emotional regulation of a patient in interpersonal psychotherapy.

Case Conferences in Inpatient Child and Adolescent Psychotherapy - Single Case Presentation and General Recommendations

Case conference in a teamgroup in inpatient psychotherapy with children and adolescents are a tool to focus those aspects of treatment relations that can not (yet) be verbalized but present themselves in actions during the treatment. This paper gives a brief overview on the theory and methodology of case conferences and refers to an ongoing study. The presentation of a case conference leads to giving some general recommendations.

Using classification trees to identify psychotherapy patients at risk for poor treatment adherence

Objective To determine the relative importance of a wide variety of personality and psychopathology variables in influencing patients’ adherence to psychotherapy treatment. Method Two classification trees were trained to predict patients’ (1) treatment utilization (i.e., their likelihood of missing a given appointment) and (2) termination status (i.e., their likelihood of dropping out of therapy prematurely). Each tree was then validated in an external dataset to examine performance accuracy. Results Patients’ social detachment was most influential in predicting their treatment utilization, followed by affective instability and activity/energy levels. Patients’ interpersonal warmth was most influential in predicting their termination status, followed by levels of disordered thought and resentment. The overall accuracy rating for the tree for termination status was 71.4%, while the tree for treatment utilization had a 38.7% accuracy rating. Conclusion Classification trees are a practical tool for clinicians to determine patients at risk of premature termination. More research is needed to develop trees that predict treatment utilization with high accuracy across different types of patients and settings.