Psychotherapy Research Articles

Engagement in Integrative and Nonpharmacologic Pain Management Modalities Among Adults with Chronic Pain: Analysis of the 2019 National Health Interview Survey.

To examine variables associated with engagement in (1) integrative health and medicine (IHM) and (2) nonpharmacologic modalities rather than opioids among United States adults with chronic pain. Using the 2019 National Health Interview Survey, we examined sociodemographic, pain, and mental health predictors of (1) the sum of IHM modalities (ie, chiropractic care, yoga/Tai Chi, massage, or meditation/guided imagery) used to manage pain and (2) exclusive engagement in nonpharmacologic pain management modalities (ie, IHM, a chronic pain self-management program, support groups, or physical, rehabilitative, occupational, or talk therapy) or opioids in the past 3 months. Metropolitan residency, higher family income, higher education levels, increased number of pain locations, and increased frequency of pain limiting life/work activities were associated with increased odds of IHM engagement. Older age, male sex, non-Hispanic Black/African American race/ethnicity, and daily opioid use were associated with decreased odds of IHM engagement. Older age, male sex, and increased depressive symptoms were associated with decreases in the count of IHM modalities used to manage pain. Metropolitan residency, higher family income, and higher education levels were associated with increased odds of exclusive nonpharmacologic modality engagement. Older age and increasing frequency of pain limiting life/work activities were associated with decreased odds of exclusive nonpharmacologic modality engagement. We identified several contrasts between factors prevalent among individuals with chronic pain and factors associated with engagement in nonpharmacologic and IHM modalities. These results support efforts to address barriers to accessing these modalities among subpopulations of adults with chronic pain (eg, older adults, individuals identifying as Black/African American, rural residents, and those with lower levels of education and income).

The concept of service model fidelity in Talking Therapies

Abstract The concept of Service Model Fidelity is considered as a parallel process to Treatment Fidelity in evidence-based psychological therapies. NHS Talking Therapies (formerly IAPT) aimed to increase access to an expanded, upskilled workforce on a national scale. This included systematic training, supervision and front-line service delivery, emphasising treatment fidelity to evidence-based interventions. A further feature of NHS Talking Therapies was modernising and restructuring of the health system that housed these trained practitioners. The term ‘service model fidelity’ (Cromarty, 2016) was coined to emphasise service modernisation aspects as a distinct entity. A definition of the latter is included. Examples of service model fidelity and of service model drift, are outlined to distinguish these from therapist drift. This links to past literature recommending changes in traditional mental health service design and emergent evidence from NHS Talking Therapies. The latter examines publicly available data identifying characteristics of service design, which appear to be predictors of enhanced clinical outcome. Challenges in modernising health systems are discussed and conclusions are made highlighting the crucial role of service model when delivering evidence-based therapies. Suggestions for further research into service configuration to improve experiences of service users are considered. This includes ongoing exploration of service design being more than a qualitative feature, and increasingly appearing as a key factor in enhanced clinical outcome. Key learning aims (1) To identify service model fidelity as separate entity to treatment fidelity. (2) To provide a clear definition of service model fidelity. (3) To delineate therapist drift from service drift. (4) To further examine the role of service model in delivering evidence-based interventions.

How to support caregivers in general practice: development of the Caregiver Care Model.

Caring for a family member can be demanding, particularly when caregivers experience profound distress. Supportive interventions may help prevent mental and physical illness in the caregiver. General practice plays a key role by regularly engaging with patients and caregivers, thereby being able to identify their support needs, offer talk therapy and refer to care initiatives. This study aimed to develop and pilot-test the Caregiver Care Model to mitigate grief reactions among caregivers in general practice. A participatory intervention development study. A prototype was developed in a workshop with healthcare professionals. The prototype was refined based on a pilot-test among 40 caregivers from 5 general practice clinics and a workshop with general practitioners. The data were obtained from workshops, feedback questionnaires completed by healthcare professionals, and interviews with caregivers and general practitioners. The analysis focused on model development and mechanisms of impact. The prototype was refined by focusing the dialogue questionnaire, minimising the grief facilitation tools and expanding the target group. The prototype seemed to accommodate the needs among caregivers by acknowledging their situation. The final model includes up to seven caregiver consultations in general practice. A dialogue questionnaire filled in by the caregiver serves as a fixed starting point and preparation for the first consultation. If needed, talk therapy in general practice or referrals to other services are used. The model offers promising support for caregivers. Its flexible structure allows for customisation. The viability of the model should be further tested.

Therapeutic alliance in individual adult psychotherapy: a systematic review of conceptualizations and measures for face-to-face- and online-psychotherapy.

The therapeutic alliance (TA) is a robust and pantheoretical predictor of treatment outcome in Face-to-Face- (F2F-) and Online-psychotherapy (Online-PT). Many authors have proposed several conceptualizations of TA, which are oftentimes operationalized. The resulting diversity of conceptualizations and measures is presented in this review. We performed a three-parted literature search for self-report-instruments of TA in individual, voluntary F2F-PT with adults (1. utilization of past reviews, 2. systematic literature search yielding 5,205 articles, 3. reference lists). Analogously, we conducted a systematic literature search for instruments of TA in the Online-setting (yielding 200 articles). Additionally, we analyzed the content of the instruments qualitatively. A current overview of 48 instruments for measuring TA (46 for F2F-PT, 2 for Online-PT) including their conceptual backgrounds, characteristics and main content aspects is presented. Most instruments (n = 24) operationalize one or more theoretical conceptualizations of TA. Other instruments are adaptation/syntheses of existing measures (n = 14), based on literature searches (n = 3) or on an empirical survey (n = 3) and two instruments provide no conceptual background information. The content of the instruments mainly focused on the following aspects: 1. Self-disclosure and authenticity; 2. Agreement; 3. Active participation, motivation and compliance; 4. Trust and secure attachment; and 5. Considering needs/abilities/wishes of the patient. Additionally, a narrative review of various approaches to conceptualize TA is presented and linked to respective corresponding instruments. The broad variety of conceptualizations and measures of TA makes coherent research on TA difficult. There are conceptual challenges such as the role of attachment style in TA that remain to be clarified. The current conceptualizations and measures do not incorporate the practical experience and expertise of psychotherapists and patients sufficiently. A metatheoretical conceptualization and measure of TA based on an empirical survey of psychotherapists and patients could address these issues.

Clinical psychologists' perceptions of telephone consultation for low-income patients during the COVID-19 pandemic: an interview study.

We will examine the processes of change in psychological practice that have been altered by the lockdown. During the COVID-19 pandemic, low-income populations, notably residents of social homes or shelters, were shown to be particularly susceptible to contagion. During lockdown, telephone-based psychological consultations became the norm. In this qualitative research, we carried out semi-structured interviews with 10 psychologists working in social homes or shelters. Interviews were transcribed verbatim. Data were studied using consensus qualitative research. During lockdown, participants felt that isolation increased while medical and social support decreased. Psychologists had to adapt their work methods and work more closely with on-site staffs. After lockdown, there was an increase in mental health issues. Participants perceived that telephone consulting seemed to facilitate access to psychological help. Although psychologists have quickly adapted, a decrease in the quality of clinical work was a general assessment. Results stress the necessity to train French psychologists in telemental health practices.

Provider perspectives on delivering telemental health services in rural North Carolina: Field report.

Provider perspectives on delivering telemental health services in rural North Carolina: Field report.

Supplemental Material for Tele-Mental Health Utilization Trends With Rural–Urban Disparities in Mississippi: 2020–2023

Supplemental Material for Tele-Mental Health Utilization Trends With Rural–Urban Disparities in Mississippi: 2020–2023

Open Trial of a Brief Imagery-Based Stabilization Psychotherapy for Adults with Acute Posttraumatic Stress Disorder.

Early intervention after trauma is needed for reduction in clinical distress and prevention of chronic posttraumatic stress disorder (PTSD). This study describes findings from an open pilot trial of a brief stabilization psychotherapy based on imagery techniques for adults with acute PTSD (i.e., within 3 months of onset). Four sessions of 60-minute individual psychotherapy were conducted on 18 participants with PTSD within 3 months after accidents, 15 of whom completed the treatment. The clinician-administered PTSD scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the Hamilton Depression and Anxiety Rating Scales, and self-questionnaires were administered at pre-treatment, post-treatment, and 6-month follow-up. Eight (53.3%) of the 15 patients at post-treatment and 8 of the 9 patients at 6-month follow-up did not meet the DSM-5 criteria for PTSD. Reliable change of PTSD symptoms after treatment was observed in 6 of 15 (45.0%) patients at post-treatment and in 4 of 9 (45.0%) patients after 6 months. There was a significant decrease in PTSD, depression, anxiety, and impaired quality of life scores after treatment, and these gains were maintained after 6 months. No cases of exacerbated PTSD symptoms were observed among completers and non-completers. Our findings suggest that brief stabilization sessions are safe treatment options for acute PTSD (KCT0001918).

Adapting low-intensity cognitive behavioural therapy for autistic adults: lessons from Plymouth’s NHS Talking Therapies and Autism Spectrum Service

Adapting low-intensity cognitive behavioural therapy for autistic adults: lessons from Plymouth’s NHS Talking Therapies and Autism Spectrum Service

Enhancing Psychological Wellbeing Practitioner (PWP) practice for depression and anxiety in the context of personality difficulties: a pilot audit of CPD workshop feedback

Abstract Psychological Wellbeing Practitioners (PWPs) are central to NHS Talking Therapies services for depression and anxiety (TTad; formerly ‘IAPT’). This workforce has been trained to deliver low-intensity treatments for mild to moderate depression and anxiety. In practice, PWPs routinely work with more complex clients, likely due to a combination of reasons. Over half of referrals experience concurrent personality difficulties, which are linked to poorer treatment outcomes, and PWPs describe feeling unskilled to work with these clients. This study aimed to develop and pilot a Continuing Professional Development workshop for PWPs about enhancing practice in the context of concurrent personality difficulties; and evaluate acceptability, feasibility and potential impacts on clinical skills and attitudes. This is an audit of routine feedback from a pilot of the workshop offered in a single TTad PWP workforce (n=139). The workshop was successfully developed and a series of five workshops were delivered to 74% of the PWP workforce. Feedback was overwhelmingly positive, and a majority of PWPs reported improved confidence in key skills covered during the workshop, and a positive attitude towards working with clients with personality difficulties after the workshop. PWPs described enhanced capability, opportunity and motivation to undertake work with this client group following the workshop. The workshop showed potential to improve PWP confidence and skill to support TTad clients in the context of personality difficulties, although it is not yet known if this translates to better treatment outcomes for clients. Implications for practice and future research are discussed. Key learning aims (1) Understand the feasibility of gathering feedback and outcome data of a Continuing Professional Development (CPD) workshop delivered in routine practice for PWPs. (2) Understand PWP perspectives on attending a CPD workshop to support tailoring PWP treatments for depression and anxiety in the context of personality difficulties. (3) Reflect on potential opportunity to enhance PWP treatments in the context of personality difficulties via brief training workshops. (4) Consider how COM-B can be used to explore barriers and enablers to PWPs implementing new learning to their practice.

Effectiveness of talking therapy on coping related to prolonged grief disorder among young adult at selected colleges in Chennai

Effectiveness of talking therapy on coping related to prolonged grief disorder among young adult at selected colleges in Chennai

Conversational AI facilitates mental health assessments and is associated with improved recovery rates

Mental health services across the globe are overburdened due to increased patient need for psychological therapies and a shortage of qualified mental health practitioners. This is unlikely to change in...

Did the pandemic lead to a change in attitudes towards cCBT? A service evaluation looking at the impact of the pandemic on practitioner beliefs regarding the routine use of cCBT within an NHS Talking Therapies Service

Abstract Computerised CBT (cCBT) is an established and evidence-based treatment for depression and some anxiety disorders. This paper aimed to replicate the study of Meisel et al. (2018), to understand more about therapist beliefs regarding offering cCBT within a service-evaluation. Meisel et al. (2018) found that although most staff in an inner-city IAPT service were confident offering cCBT to clients, staff believed there was not a strong evidence-base, and training on cCBT was identified as a solution to low cCBT uptake. The unexpected COVID-19 pandemic provided an opportunity to collect additional data to understand the impact of significant societal changes and service delivery methods to see if this led to a change in attitudes towards cCBT as Wind et al. (2020) hypothesised. Data on staff beliefs about the provision of cCBT from one rural UK Talking Therapies service is presented across three time points: pre-COVID pandemic, post-COVID pandemic, and following additional cCBT training. Staff completed a survey at each time point, containing agree/disagree ratings and free-text questions, obtaining perspectives on cCBT including advantages, barriers/problems, and confidence. This paper reports staff opinions with commentary on how they have changed over time. Between time points 1 and 3, agreement with the statement ‘supporting clients using cCBT requires a high level of skill’ increased by 29%. Several beliefs did not change, despite moving towards more remote working in the pandemic, and training. Although the paper illustrates some changes in beliefs over time, it does not provide support for changes in therapist beliefs, with reasons for this examined. Key learning aims (1) Following reading this paper, the reader will understand changes in staff beliefs and attitudes towards cCBT that occurred between pre-pandemic and post-pandemic time points in one NHS Talking Therapies service. (2) The reader will also be aware of the beliefs that have not changed following both the pandemic and additional staff training on cCBT and will be able to consider why this might be and whether it may be generalisable across wider services. (3) The reader will be aware of potential interventions that could be introduced to try and address the ‘stubborn beliefs’ around cCBT that are not consistent with the evidence-base and may limit patient access to this option.

A pilot evaluation of a training and supervision pathway for Augmented Depression Therapy (ADepT) in a Devon NHS Talking Therapies Service

Abstract Augmented Depression Therapy (ADepT) is a novel wellbeing and recovery-oriented psychological treatment for depression. A recent pilot trial run in a university clinic setting suggests ADepT has potential to be superior to cognitive behavioural therapy (CBT) at treating anhedonic depression in a NHS Talking Therapies for anxiety and depression (NHS–TTad) context. Before proceeding to definitive trial in pragmatic settings, it is important to establish if therapists in routine NHS-TTad settings can be trained to deliver ADepT effectively and to assess therapist views on the feasibility and acceptability of ADepT in this context. A bespoke training and supervision pathway was developed (2-day workshop, four 2–hour skills classes, and 6 months of weekly supervision) and piloted with 11 experienced therapists working in a single NHS–TT service in Devon. Nine out of 11 therapists completed the placement, treating 24 clients with a primary presenting problem of depression; 21/24 completed a minimum adequate dose of therapy (≥8 sessions), with 17/24 (71%) showing reliable improvement and 12/24 (50%) exhibiting reliable recovery. Eight out of nine therapists submitted a session for competency assessment, all of whom were rated as competent. Nine therapists submitted feedback on their experiences of training. Eight out of nine therapists felt the ADepT model would be effective in an NHS–TTad context; that training was interesting, useful, well presented and enhanced their own wellbeing; and that they felt sufficiently skilled in core ADepT competencies at the end of the placement. This suggests that NHS–TTad therapists can be trained to deliver ADepT competently and view the treatment as feasible and acceptable. Key learning aims (1) To become familiar with the Augmented Depression Therapy (ADepT) approach for enhancing wellbeing in depression. (2) To evaluate the potential utility and feasibility of ADepT model in NHS Talking Therapies Services (NHS–TTad). (3) To understand the pilot ADepT training and supervision pathway for CBT therapists in NHS–TTad services. (4) To consider the opportunities and challenges of training therapists to deliver ADepT in NHS–TTad services.

Psychotherapy as an expansion of activities addressed to clients of aid institutions and organisations

Looking at the narratives given by conumers of aid services, it seems in many situations the scope of support should be expanded to include psychotherapy. This happens primarily when the expected impact of institutional support is not sufficient due to childhood traumas, unprocessed losses, rejection by significant others, toxic family system that all preclude proper functioning. This article discusses most popular psychotherapy modalities practiced in Poland that have scientific basis (cognitive behavioral, psychodynamic, humanistic, systemic) as well as forms of psychotherapy (individual psychotherapy, group psychotherapy, family therapy, couples therapy). The author indicates practical aspects of psychotherapy services functioning in Poland in a widely construed mental health and social assistance services sphere.

Management of Huntington’s Disease by Faecal Microbiota Transplant (FMT) Technology

Huntington's disease (HD) is an inherited autosomal dominant neurodegenerative disorder in which nerve cells in the brain break down over the time. Huntington's disease results in a decline in thinking and reasoning skills, including memory, concentration, judgment, and ability to plan and organize. Brain changes in this disease lead to alterations in mood, especially depression, anxiety, uncharacteristic anger and irritability. Unfortunately, no cure exists, but drugs, physiotherapy and talk therapy can help to manage some symptoms. Bidirectional communication between the gut microbiome and central nervous system via gut-brain axis gives a clue that dysbiosis of the gut microbiota in HD is the causal factor for the prognosis of the disease. Promising results were obtained from Faecal Microbiota Transplant (FMT) treatment in human trials and animal models are discussed here. The intensity of the symptoms could be reduced by FMT

Hiring Permanently Remote Clinical Staff at University Counseling Centers: A Descriptive and Qualitative Exploration of Barriers and Implications for Student Mental Health

ABSTRACT The COVID-19 pandemic has had a marked influence on the nature of psychotherapy in the transition from predominantly in-person services to predominantly remote, telemental health services, to an intermediary hybrid model. Increased availability of telehealth services has been denoted a point of equity in meeting service needs of diverse groups of people across the United States. However, some University and College Counseling Centers (UCCCs) have rapidly rolled back telemental health provisions in favor of in-person or hybrid models of practice, even amidst increased use of counseling services, pressure to expand service availability, and difficulties with clinical staff retention. To explore this phenomenon, 75 UCCC administrators in the U.S. were surveyed to elucidate the nature of remote staffing in UCCCs, including administrative perspectives regarding barriers to hiring permanently remote staff (PRS). Five thematic barriers to hiring PRS were identified: Institutional Roadblocks, Team Ethos, Equity in Clinical Duties, Student Demand, and Service Quality Concerns. A majority of these barriers coded into categories that were chronic and autonomy-limiting in nature. Implications and recommendations for UCCCs and college student wellness are discussed.

Telemental health services during COVID-19 outbreak in Saudi Arabia

COVID-19, which was declared a pandemic by WHO, brings up many problems. Telemental health comes as a solution to mental problems that are difficult to deal with because of social and physical distancing policies. This study aims to describe the telemental health services in Saudi Arabia during the COVID-19 outbreak. This paper outlines the general approach Saudi Arabia has taken in delivering public mental health services. It describes several key areas of work: medical staff, COVID-19 patients and their families, and individuals who feel anxious due to COVID-19. A description of the program that Saudi Arabia has produced is described, which targeted various groups with various methods. The program from Saudi Arabia may assist in informing public mental health services during COVID-19 or other crises that other government agencies could consider adopting. There is limited published information on this topic in Saudi Arabia. This paper gives a piece of detailed information on mental health services during the COVID-19 outbreak.

Personality disorder type only sometimes matters: An exploration of patient's personality disorder as a source of variance in early therapeutic alliance.

The study aimed to analyse personality disorders among patients in the early phase of psychotherapy as a source of variance in the quality of the emerging alliance. The sample consisted of 131 individual psychotherapy patients with borderline (BPD), narcissistic (NPD), dependent (DPD) and obsessive-compulsive (OCPD) personality disorders and 131 psychotherapists. Different sources of alliance estimation were included. Therapeutic alliance was operationalized on several dimensions. The hypothesis was tested using an independent samples one-way analysis of variance. The study revealed a significant effect of personality disorder type on early therapeutic alliance quality. BPD patients rated their early alliance the lowest compared to NPD, DPD and OCPD patients. This trend was dominant and replicated regardless of who rated the alliance and which dimension of alliance was estimated. NPD, DPD and OCPD patients have better initial therapeutic alliances than BPD patients, and their alliances do not differ significantly. BPD patients build weaker alliances, and what poses a challenge for them is not only developing a strong and close bond but also conceptualizing goals and reaching agreement on tasks.

Effectiveness-implementation hybrid trial of Spanish language, digital cognitive-behavioral therapy (dCBT) intervention for depression and anxiety – protocol for the SUPERA (SUpport from PEeRs to expand Access) study

BackgroundLimited English Proficiency (LEP) Latinxs experience a longer duration of untreated depression and anxiety. LEP Latinxs have difficulty accessing mental healthcare due to insufficient Spanish-speaking behavioral/mental health clinicians to meet demand. These under-resourced healthcare systems are less likely to be the site for the implementation of innovations. Digital interventions can provide an effective option for overcoming these barriers; yet, when digital evidence-based treatments are available, uptake and engagement is often low. This manuscript presents the protocol for the SUPERA (SUpport from PEeRs to expand Access) study which will evaluate the implementation of an evidence-based, Spanish language, digital cognitive-behavioral therapy (dCBT) intervention (i.e., SilverCloud) in safety-net primary care clinics for LEP Latinx patients with depression or anxiety. MethodsWe will conduct an effectiveness-implementation hybrid trial (Type 2) design comparing engagement and clinical outcomes in two modalities of dCBT delivery (peer-supported vs. unsupported). We will also compare provider-level outreach (using a clinic patient registry) versus inreach (traditional provider referral) to compare rates of initiation, completion, and cost. Participants will be 426 LEP Latinx adults ≥18 years of age, PHQ-9 ≥ 10 or GAD-7 ≥ 8, with access to the internet via smartphone, and not currently receiving individual psychotherapy. We will collect baseline, post-intervention (8 weeks), and follow up (3 months) data. ConclusionThe long-term goal of this research is to aid in the implementation of digital mental health interventions that can be sustainably implemented in low-resourced settings, while reducing the reliance on professionals, overcoming workforce deficits, and increasing relevance for diverse populations.