Specific Mechanisms Of Change Research Articles

Beyond mediators: A critical review and methodological path forward for studying mechanisms in alcohol use treatment research.

Understanding how treatments for alcohol use disorder (AUD) facilitate behavior change has long been recognized as an important area of research for advancing clinical care. However, despite decades of research, the specific mechanisms of change for most AUD treatments remain largely unknown because most prior work in the field has focused only on statistical mediation. Statistical mediation is a necessary but not sufficient condition to establish evidence for a mechanism of change. Mediators are intermediate variables that account statistically for the relationship between independent and dependent variables, whereas mechanisms provide more detailed explanations of how an intervention leads to a desired outcome. Thus, mediators and mechanisms are not equivalent. To advance mechanisms of behavior change research, in this critical review we provide an overview of methodological shortfalls of existing AUD treatment mechanism research and introduce an etiologically informed precision medicine approach that facilitates the testing of mechanisms of behavior change rather than treatment mediators. We propose a framework for studying mechanisms in alcohol treatment research that promises to facilitate our understanding of behavior change and precision medicine (i.e., for whom a given mechanism of behavior change operates and under what conditions). The framework presented in this review has several overarching goals, one of which is to provide a methodological roadmap for testing AUD recovery mechanisms. We provide two examples of our framework, one pharmacological and one behavioral, to facilitate future efforts to implement this methodological approach to mechanism research. The framework proposed in this critical review facilitates the alignment of AUD treatment mechanism research with current theories of etiologic mechanisms, precision medicine efforts, and cross-disciplinary approaches to testing mechanisms. Although no framework can address all the challenges related to mechanisms research, our goal is to help facilitate a shift toward more rigorous and falsifiable behavior change research.

Evaluating the effectiveness of two behaviour change techniques designed to improve safe food-handling among consumers

Purpose Safe food-handling media campaigns have been successful at improving some safe food-handling behaviours among consumers. However, little is known about whether specific mechanisms of change, such as habit and perceived risk, can improve the effectiveness of safe food-handling campaign materials. Consequently, this study aims to determine if habit and risk-based behaviour change techniques can improve the effectiveness of safe food-handling media campaign materials. Design/methodology/approach A prospective experimental design was used. Participants completed baseline measures of habit, perceived risk and behaviour before watching two short safe food-handling video advertisements. Participants were then randomly assigned to complete either a habit or a perceived risk-based behaviour change technique task. Two weeks later, participants completed the baseline measures again. A series of multivariate analyses of variance were conducted to determine differences over time between the two groups in relation to habit, perceived risk and behaviour. Findings Significant increases in habit (p < 0.001), perceived risk (p < 0.001) and behaviour (p < 0.001) among all participants were found over the study period. However, there were no significant differences in these changes between participants who completed either task for the majority of the target behaviours and related constructs. This suggested that both habit and risk-based behaviour change techniques may help improve campaign materials; however, future research is needed to determine these effects in comparison to a non-active control group. Originality/value To the best of the authors’ knowledge, this is the first study to compare the use of two behaviour change techniques for improving safe food-handling health messaging materials. Future safe food-handling media campaigns would benefit from including habit and risk-based behaviour change techniques.

Unveiling mechanisms of change in digital interventions for depression: Study protocol for a systematic review and individual participant data meta-analysis.

IntroductionThe efficacy and effectiveness of digital interventions for depression are both well-established. However, precise effect size estimates for mediators transmitting the effects of digital interventions are not available; and integrative insights on the specific mechanisms of change in internet- and mobile-based interventions (IMIs)—as related to key features like delivery type, accompanying support and theoretical foundation—are largely pending.ObjectiveWe will conduct a systematic review and individual participant data meta-analysis (IPD-MA) evaluating the mediators associated with therapeutic change in various IMIs for depression in adults.MethodsWe will use three electronic databases (i.e., Embase, Medline/PubMed, PsycINFO) as well as an already established database of IPD to identify relevant published and unpublished studies. We will include (1) randomized controlled trials that examine (2) mediators of (3) guided and unguided (4) IMIs with (5) various theoretical orientations for (6) adults with (7) clinically relevant symptoms of depression (8) compared to an active or passive control condition (9) with depression symptom severity as primary outcome. Study selection, data extraction, as well as quality and risk of bias (RoB) assessment will be done independently by two reviewers. Corresponding authors of eligible primary studies will be invited to share their IPD for this meta-analytic study. In a 1-stage IPD-MA, mediation analyses (e.g., on potential mediators like self-efficacy, emotion regulation or problem solving) will be performed using a multilevel structural equation modeling approach within a random-effects framework. Indirect effects will be estimated, with multiple imputation for missing data; the overall model fit will be evaluated and statistical heterogeneity will be assessed. Furthermore, we will investigate if indirect effects are moderated by different variables on participant- (e.g., age, sex/gender, symptom severity), study- (e.g., quality, studies evaluating the temporal ordering of changes in mediators and outcomes), and intervention-level (e.g., theoretical foundation, delivery type, guidance).DiscussionThis systematic review and IPD-MA will generate comprehensive information on the differential strength of mediators and associated therapeutic processes in digital interventions for depression. The findings might contribute to the empirically-informed advancement of psychotherapeutic interventions, leading to more effective interventions and improved treatment outcomes in digital mental health. Besides, with our novel approach to mediation analyses with IPD-MA, we might also add to a methodological progression of evidence-synthesis in psychotherapy process research.Study registration with Open Science Framework (OSF)https://osf.io/md7pq/.

The Evidence Base for How and Why Infant and Early Childhood Mental Health Consultations Works

Infant and Early Childhood Mental Health Consultation (IECMHC) is an evidence-based service in which consultants build capacity for early childhood professionals and programs to promote the social-emotional development of infants and young children. This paper describes the current state of the evidence for IECMHC, mapping the evidence to a new theory of change from the Center of Excellence (CoE) for IECMHC. There is a substantial literature base regarding the effects of consultation on outcomes for infants and young children; yet the evidence for consultation’s specific mechanisms of change, moderators of impact, and reductions in disparities have been understudied. The authors identify gaps in the scholarly literature, articulate next steps for research, and conclude with a call to action for IECMHC researchers to expand rigorous studies to the range of settings in which IECMHC is implemented and to center social justice in the research questions, methods, and dissemination.

Therapists' Views of Mechanisms of Change in Psychotherapy: A Mixed-Method Approach.

The question of what works in psychotherapy has been a subject of debate in the recent years, occupying both clinicians and researchers. In this study, we aimed to assess the current perspectives held by clinicians regarding the processes which produce changes in psychotherapy, as well as the predictors of specific views. Licensed therapists (n = 107), consisting mainly of psychodynamically and integratively oriented psychologists, were asked to write in their own words what they think works in psychotherapy. Thematic analysis was employed to assess the main mechanisms of change as perceived by the therapists. Differences in the prevalence of specific themes were assessed using Friedman and Wilcoxon signed-rank tests. Univariate logistic regressions were employed to assess the factors that predict the probability of reporting a specific mechanism of change. The results indicated that the therapeutic bond was the most highly reported mechanism of change, followed by theory-driven mechanisms of change, therapist characteristics, therapist professionalism, and client motivation. Male therapists were more likely to indicate the professionalism as a mechanism of change compared to female therapists. Higher education was associated with lower reports of therapists’ characteristics as the mechanisms of change. These results suggest that therapists acknowledge the importance of the working alliance, and that the perception of the mechanism of change is associated with various factors which comprise therapist orientation. Limitations and directions for future research are discussed.

Changes in alcohol use during the COVID-19 pandemic in Europe: A meta-analysis of observational studies.

IssuesNumerous studies have examined the impact of the COVID‐19 pandemic on alcohol use changes in Europe, with concerns raised regarding increased use and related harms.ApproachWe synthesised observational studies published between 1 January 2020 and 31 September 2021 on self‐reported changes in alcohol use associated with COVID‐19. Electronic databases were searched for studies evaluating individual data from European general and clinical populations. We identified 646 reports, of which 56 general population studies were suitable for random‐effects meta‐analyses of proportional differences in alcohol use changes. Variations by time, sub‐region and study quality were assessed in subsequent meta‐regressions. Additional 16 reports identified were summarised narratively.Key FindingsCompiling reports measuring changes in overall alcohol use, slightly more individuals indicated a decrease than an increase in their alcohol use during the pandemic [3.8%, 95% confidence interval (CI) 0.00–7.6%]. Decreases were also reported more often than increases in drinking frequency (8.0%, 95% CI 2.7–13.2%), quantity consumed (12.2%, 95% CI 8.3–16.2%) and heavy episodic drinking (17.7%, 95% CI 13.6–21.8%). Among people with pre‐existing high drinking levels/alcohol use disorder, high‐level drinking patterns appear to have solidified or intensified.ImplicationsPandemic‐related changes in alcohol use may be associated with pre‐pandemic drinking levels. Increases among high‐risk alcohol users are concerning, suggesting a need for ongoing monitoring and support from relevant health‐care services.ConclusionOur findings suggest that more people reduced their alcohol use in Europe than increased it since the onset of the pandemic. However high‐quality studies examining specific change mechanisms at the population level are lacking.

Temporal and specific pathways of change in cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for depression

BackgroundThe present study investigated the specific and temporal role of putative mechanisms of change in cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD). Method200 patients were randomized to CBT weekly, CBT twice weekly, IPT weekly or IPT twice weekly. Outcome and putative mechanisms of change (i.e., dysfunctional thinking, behavioral activation, CBT skills, IPT skills, therapeutic alliance, compliance, motivation) were measured multiple times up to six months after the start of treatment. Latent change score models were used to investigate temporal relations and test mediation. Explorative analyses tested whether baseline working memory moderated the effect of mechanism change on outcome change. ResultsCBT skills and dysfunctional thinking mediated the relation between treatment modality and changes in depression. In both treatments, IPT skills and behavioral activation were related to subsequent change in depression while a decrease in depression led to subsequent improvement in therapeutic alliance and a decrease in autonomous motivation. Change in compliance was unrelated to change in depression. Baseline working memory was related to therapy skill improvement. ConclusionCBT skill improvement seems a specific mechanism of change leading to subsequent decrease in depression in CBT. Changes in IPT skills acted as a non-specific mechanism, subsequently reducing depression regardless of treatment modality. The specific role of cognitive change and behavioral activation remains unclear. Future studies should investigate the specificity and direction of the potential mechanisms of change throughout the course of therapy and investigate whether these mechanistic pathways differ between individuals.

Resting-State Functional Magnetic Resonance Imaging and Functional Connectivity Density Mapping in Patients With Optic Neuritis.

Background: Using resting-state functional connectivity (rsFC), we investigated alternations in spontaneous brain activities reflected by functional connectivity density (FCD) in patients with optic neuritis (ON).Methods: We enrolled 28 patients with ON (18 males, 10 females) and 24 healthy controls (HCs; 16 males, 8 females). All subjects underwent functional magnetic resonance imaging (fMRI) in a quiet state to determine the values of rsFC, long-range FCD (longFCD), and short-range FCD (IFCD). Receiver operating characteristic (ROC) curves were generated to distinguish patients from HCs.Results: The ON group exhibited obviously lower longFCD values in the left inferior frontal gyrus triangle, the right precuneus and the right anterior cingulate, and paracingulate gyri/median cingulate and paracingulate gyri. The left median cingulate and paracingulate gyri and supplementary motor area (SMA) were also significantly lower. Obviously reduced IFCD values were observed in the left middle temporal gyrus/angular gyrus/SMA and right cuneus/SMA compared with HCs.Conclusion: Abnormal neural activities were found in specific brain regions in patients with ON. Specifically, they showed significant changes in rsFC, longFCD, and IFCD values. These may be useful to identify the specific mechanism of change in brain function in ON.

To whom should I be kind? A randomized trial about kindness for strong and weak social ties on mental wellbeing and its specific mechanisms of change

The current study examines the role of social ties in performing kind acts to enhance university students’ wellbeing. Due to facing multifaceted challenges, university students form a group that is particularly vulnerable in terms of their mental health. Interventions harnessing prosocial behaviour have the potential to increase students’ wellbeing, strengthen personal competencies, and broaden social networks. The first aim of the trial (N = 222) was to explore whether a 4-week acts-of-kindness intervention targeting either (1) strong social ties, (2) weak social ties or (3) unspecified receivers (treatment-as-usual) differ in their impact on students’ mental wellbeing, positive relations, depressive symptoms, anxiety, and perceived stress. The second aim was to examine whether kindness for strong versus weak social ties have different underlying working mechanisms (i.e., positive emotions versus self-esteem) and who benefits most from these instructions (i.e., those with high or low levels of self-esteem and positive relations). Results demonstrated that the most significant improvements in mental wellbeing were found in the kindness for strong social ties condition compared to the other conditions. No mediation effects of positive emotions and self-esteem were found. Moderation analyses revealed that participants who performed kind acts for weak social ties reported significantly less positive effects on mental wellbeing, but only when their levels of self-esteem at baseline were medium or high. Independent of group allocation, participants’ mental wellbeing increased throughout the intervention, but so did the experience of depressive symptoms, anxiety, and perceived stress. More research is needed to examine the timing of kindness interventions and investigate how they can improve mental wellbeing and psychological distress in acute phases of academic stress in university students.

Mediators and Theories of Change in Psychotherapy for Young People With Personality Disorders: A Systematic Review Protocol.

Background: Personality disorders (PDs) are a severe health issue already prevalent among adolescents and young adults. Early detection and intervention offer the opportunity to reduce disease burden and chronicity of symptoms and to enhance long-term functional outcomes. While psychological treatments for PDs have been shown to be effective for young people, the mediators and specific change mechanisms of treatment are still unclear.Aim: As part of the “European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders” (TREATme), funded by the European Cooperation in Science and Technology (COST), we will conduct a systematic review to summarize the existing knowledge on mediators of treatment outcome and theories of change in psychotherapy for young people with personality disorders. In particular, we will evaluate whether mediators appear to be common or specific to particular age groups, treatment models, or outcome domains (e.g., psychosocial functioning, life quality, and adverse treatment effects).Method: We will follow the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched for prospective, longitudinal, and case–control designs of psychological treatment studies, which examine mediators published in English. Participants will be young people between 10 and 30years of age who suffer from subclinical personality symptoms or have a personality disorder diagnosis and receive an intervention that aims at preventing, ameliorating, and/or treating psychological problems.Results: The results will be published in a peer-reviewed journal and at conference presentations and will be shared with relevant stakeholder groups. The data set will be made available to other research groups following recommendations of the open science initiative. Databases with the systematic search will be made openly available following open science initiatives. The review has been registered in PROSPERO (evaluation is pending, registration number ID 248959).Implications: This review will deliver a comprehensive overview on the empirical basis to contribute to the further development of psychological treatments for young people with personality disorders.

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...

Relational savoring: An attachment-based approach to promoting interpersonal flourishing.

Our purpose is to introduce a novel technique for evoking emotions associated with moments of closeness with another person (relational savoring), to describe its theoretical grounding, specifics of treatment targets and outcomes, as well as to provide the preliminary evidence for its efficacy in promoting flourishing. We rely on attachment theory, the broaden-and-build theory of positive emotions, and emotion-focused therapy as foundations for our understanding of how secure relationships are built and maintained and for proposing how relational savoring can promote flourishing through strengthening relationships. To illustrate specific mechanisms of change, we provide examples from a recently completed study of mothers of young children. Finally, we discuss how the technique can be integrated into clinical practice as well as how it might be used to augment other forms of therapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Reflective functioning, psychotherapeutic alliance, and outcome in two psychotherapies for bulimia nervosa.

Mentalization is a developmental achievement defined as the capacity to understand behavior in terms of mental states. This study investigated mentalization in psychoanalytic psychotherapy (PPT) and cognitive behavior therapy (CBT) through a secondary data analysis of findings from a randomized controlled trial for bulimia nervosa. It was hypothesized that mentalization would predict alliance and outcome in both treatments, whereas increase in mentalization was only expected after PPT. Furthermore, it was investigated whether change in mentalization predicted symptom change. A total of 70 participants with bulimia nervosa were randomized to PPT or CBT. Participants were assessed at 3 time points with the Eating Disorder Examination and the Adult Attachment Interview (rated for reflective functioning [RF]). Therapy sessions were rated with the Vanderbilt Therapeutic Alliance Scale. Higher intake RF significantly predicted better alliance, whereas no association was observed between RF and outcome. A significant interaction between time, therapy type, and RF found RF improving more in PPT than in CBT. There was a significant association between RF change and symptom change in the PPT group. The study suggests a relation between RF and psychotherapy process, whereas the relation between RF and outcome is more complex. Furthermore, PPT seems to enhance mentalization, which seems related to symptomatic improvement, suggesting that mentalization might serve as a specific mechanism of change in PPT. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

How specific is cognitive change? A randomized controlled trial comparing brief cognitive and mindfulness interventions for depression

Objective: There is a debate in psychotherapy research as to whether different kinds of psychotherapy work through specific mechanisms of change. Particularly, it is questioned whether cognitive change is specific to cognitive therapy. This study aimed to answer this question by comparing a brief cognitive intervention with an active comparison intervention (i.e., brief mindfulness-based intervention) and by following strict methodological guidelines. Method: 72 currently depressed outpatients were randomized to either cognitive intervention (n = 39) or mindfulness-based intervention (n = 33). Automatic thoughts (negative self-statements, well-being, and self-confidence), dysfunctional attitudes (performance evaluation and approval by others) and depressive symptoms were assessed before and six times during treatment. Within-person and between-person mediation effects were analyzed using multilevel structural equation modeling. Results: There was no difference in cognitive change between the interventions. Negative self-statements and performance evaluations were significant mediators of the within-person effect of time on depressive symptoms, while the three other cognitive variables did not change. Conversely, change in depressive symptoms also mediated within-person cognitive change. Conclusion: Cognitive change seems to be a general rather than a specific mechanism of change. However, the mutual impact of cognitive and depressive change does not support a unidirectional causal model.

Mentalization-Based Treatment for Personality Disorders: Efficacy, Effectiveness, and New Developments.

This review aims to outline the most recent evidence on the efficacy and effectiveness of mentalization-based treatment (MBT) for personality disorders (PD) from 2015 to 2018 and to describe new treatment developments. Since 2015, 14 new-primarily effectiveness-MBT trials have been published. The main body of studies investigated adult populations (n = 11), patients with a borderline personality disorder (BPD) diagnosis (n = 8), and compared MBT with another psychotherapeutic treatment (n = 6). The majority of studies suggest that MBT has the potential to improve the clinical outcomes for adolescents and adults with a PD diagnosis, particularly BPD, and also with comorbid diagnoses and there are indications for changes in mentalizing being a specific mechanism of change promoted by MBT. Despite promising findings, there is an urgent need for methodological sound and sufficiently powered studies to investigate both the efficacy and effectiveness of MBT, especially beyond BPD.

Alcohol Consumption Reduction Among a Web-Based Supportive Community Using the Hello Sunday Morning Blog Platform: Observational Study.

BackgroundAlcohol misuse is a major social and public health issue in Australia, with an estimated cost to the community of Aus $30 billion per annum. Until recently, a major barrier in addressing this significant public health issue is the fact that the majority of individuals with alcohol use disorders and alcohol misuse are not receiving treatment.ObjectiveThis study aimed to assess whether alcohol consumption changes are associated with participation in Hello Sunday Morning’s blog platform, an online forum discussing experiences in abstaining from alcohol.MethodsThe study reports on Hello Sunday Morning participants who signed up for a 3-month period of abstinence from November 2009 to November 2016. The sample comprised 1917 participants (female: 1227/1917, 64.01%; male: 690/1917, 35.99%). Main outcome measures were Alcohol Use Disorders Identification Test (AUDIT) scores, mood, program engagement metrics, and slip-ups.ResultsIndividuals who reported hazardous (preprogram AUDIT mean 11.92, SD 2.25) and harmful consumption levels (preprogram AUDIT mean 17.52, SD 1.08) and who engaged in the Hello Sunday Morning program reported a significant decrease in alcohol consumption, moving to lower risk consumption levels (hazardous, mean 7.59, SD 5.70 and harmful, mean 10.38, SD 7.43), 4 months following program commencement (P<.001). Those who reported high-risk or dependent consumption levels experienced the biggest reduction (preprogram mean 25.38, SD 4.20), moving to risky consumption (mean 15.83, SD 11.11), 4 months following program commencement (P<.001). These reductions in risk were maintained by participants in each group, 7 months following program commencement. Furthermore, those who engaged in the program more (as defined by more sign-ins, blogs posted, check-ins completed, and engagement with the community through likes and following) had lower alcohol consumption. Finally, those who experienced more slip-ups had lower alcohol consumption.ConclusionsParticipation in an online forum can support long-term behavior change in individuals wishing to change their drinking behavior. Importantly, reductions in AUDIT scores appeared larger for those drinking at high-risk and hazardous levels before program commencement. This has promising implications for future models of alcohol reduction treatment, as online forums are an anonymous, accessible, and cost-effective alternative or adjunct to treatment-as-usual. Further research is needed into the specific mechanisms of change within a Web-based supportive community, as well as the role of specific mood states in predicting risky drinking behavior.

Psychological Theories of Pain

While pain has traditionally been understood within a medical model that equates pain to tissue damage or disease, this understanding is not consistent with everyday observations of pain or with clinical examples of persistent pain where there is often very little correlation between pain experienced and physical findings.<br/> This article considers psychological and multidimensional theories of pain, which are described within the historical context within which they were developed, including behavioural, cognitive, contextual and functional theories.<br/> Research into the multifactorial nature of persistent pain has tended to focus on mechanisms of pain development and maintenance or on the function of pain. psychological approaches, which have focused on mechanism traditionally use disability, mood and quality of life measures to assess outcome, claiming little or no impact on pain intensity itself. By contrast, functional approaches include an explicit goal of reducing pain intensity, which is therefore measured as a key treatment outcome.<br/> Strong evidence exists from a range of sources of the important contribution of psychological and social factors to the experience of pain. However, evidence is still lacking about the specific mechanisms of change that are targeted by biopsychosocial interventions and about what treatment approach is likely to work best for whom.

Using counterattitudinal advocacy to change drinking: A pilot study.

The persistence of risky drinking among young adults in college calls for continued efforts to prevent alcohol-related harms. This study tested a novel prevention strategy targeting a specific mechanism of change: creating attitude-behavior dissonance. Informed by an extensive literature showing strong and consistent associations between alcohol attitudes and drinking behavior, we adapted a brief counterattitudinal advocacy (CAA) manipulation to the alcohol prevention context. We conducted a small randomized controlled trial with 49 heavy-drinking students who reported drinking 4/5 drinks in 1 sitting (female/male, respectively) and endorsed ≥2 alcohol-related consequences in the previous month. Participants were randomly assigned to 1 of 2 conditions (CAA or control). We examined the number of words written in response to the prompts, evaluated adherence to the core theoretical principles used in CAA, and calculated between- and within-group effect sizes on preliminary outcomes (drinking intentions and alcohol consumption). We found that participants in the CAA condition wrote more, and the experience was perceived as consistent with CAA theory. The between-group effect sizes on drinking intentions and drinks per week were d = .36 and d = .27, respectively, and the within-group effect size for drinks per week was d = .83 for those in the CAA condition. Overall, the results of this pilot study support the feasibility and acceptability of CAA-based alcohol use interventions. This study represents a promising first step in adapting CAA-based interventions for use in the alcohol use domain. (PsycINFO Database Record

Patients' experiences of cognitive behavioural therapy and eye movement desensitisation and reprocessing as treatments for obsessive‐compulsive disorder

AbstractIntroductionObsessive‐compulsive disorder (OCD) is usually treated with cognitive behavioural therapy (CBT) based on exposure and response prevention principles; although eye movement desensitisation and reprocessing (EMDR) has also been proposed as a potentially helpful treatment.AimTo investigate patients’ experiences of the process and outcome of CBT and EMDR.MethodWe conducted in‐depth qualitative interviews with 24 (EMDR = 14; CBT = 10) patients who participated in a randomised controlled trial. Interviews were conducted after the end of therapy, transcribed verbatim and interpreted using thematic analysis.ResultsThree superordinate themes were identified, including (1) common experiences and specific experiences of (2) CBT and (3) EMDR. Common experiences of therapy included difficulties in disclosing OCD problems; perceptions about therapists as approachable and nonjudgemental; sudden symptomatic improvements; difficulties in engaging with treatment; general satisfaction with therapy; and viewing OCD as a long‐term condition. Some differences between these interventions were also found in patients’ understanding of the treatment rationale, their experiences and difficulties with specific treatment procedures.ConclusionsCommon process factors were especially prominent in patients’ accounts, although it is possible that these interact with more specific change mechanisms such as desensitisation.

Tinnitus-related fear: Mediating the effects of a cognitive behavioural specialised tinnitus treatment

ObjectiveCognitive behavioural treatments (CBT) for the reduction of tinnitus complaints have been shown to be effective; however the specific mechanisms of change are yet to be unveiled. Reductions in tinnitus-related fear have been indicated to be an important factor in alleviating tinnitus suffering. The role of tinnitus-related fear has been proposed as a mediator explaining the cognitive behavioural treatment effects on tinnitus severity, tinnitus-related impairment and general quality of life of tinnitus patients. MethodsA two-group, single-centre RCT was carried out with adult tinnitus patients (n = 492), with 3 follow-up assessments up to 12 months after randomization. Patients were randomly assigned to Usual Care (UC) or Specialised cognitive behavioral stepped Care (SC). A repeated-measures design, with group as a between subjects factor, and time as the within-subject factor, was used in an intention-to-treat analysis. Mixed regressions for assessing mediation effects were performed with general health, tinnitus distress, tinnitus related impairment as the dependent variables and tinnitus related fear as the mediator variable. ResultsTinnitus-related fear appears to mediate part of the treatment benefits of specialized CBT for Tinnitus, as compared to usual care, with respect to increased quality of life ratings, and decreased tinnitus severity and tinnitus related impairments. ConclusionsThe effectiveness of specialized cognitive behavioural treatment approaches for tinnitus might be partly explained by significant reductions in tinnitus-related fear. These results are relevant in that currently, though CBT approaches in tinnitus management have been proven to lead to decreased suffering of tinnitus patients, the psychological mechanisms causing these benefits are still to be discovered.