J Consult Clin Psychol [JOURNAL]
Sun
200 papers
Covariation of symptomatic and mechanistic change during dialectical behavior therapy for suicidal self-harming youth.
Bedics JD, Asarnow JR, Berk MS … +2 more , McCauley E, Gallop R
J Consult Clin Psychol · 2026 Feb · PMID 41712337 · Publisher ↗
OBJECTIVE: The effectiveness of psychotherapy for suicidal youth remains a public health priority. Dialectical behavior therapy (DBT; Linehan, 1993) has been recognized as a well-established treatment for suicidal youth...
OBJECTIVE: The effectiveness of psychotherapy for suicidal youth remains a public health priority. Dialectical behavior therapy (DBT; Linehan, 1993) has been recognized as a well-established treatment for suicidal youth (Witt et al., 2021). Although promising, little work has explored mechanisms of change in DBT for suicidal youth (Asarnow et al., 2021). This study aimed to examine covariation in rates of change between symptoms and theorized mechanistic variables during a randomized controlled trial of DBT for suicidal youth. METHOD: The present study was a secondary data analysis of a randomized controlled trial of DBT for 173 suicidal youth (ages 12-18; McCauley et al., 2018). Multilevel modeling was used to examine the association between person-level rates of change for self-harm (suicide attempts and nonsuicidal self-injury), suicidal ideation, DBT skills, emotion dysregulation, and reasons for living. RESULTS: Both treatment groups showed statistically significant covariation between reductions in self-harm and suicidal ideation. Rates of change in self-harm and suicidal ideation decreased with improvement in emotion regulation for both treatments. An increase in endorsed reasons for living significantly covaried with reductions in self-harm and suicidal ideation within the DBT condition only. CONCLUSIONS: Study results support the potential value of efforts to reduce suicidal ideation and self-harm through improving emotion regulation and demonstrate common and unique mechanisms of change across treatments for youths at elevated suicide/self-harm risk. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Who benefits most from couple relationship education: A machine learning approach.
Chen PH, Williamson HC
J Consult Clin Psychol · 2026 Jan · PMID 41538203 · Publisher ↗
OBJECTIVE: Couple relationship education (CRE) seeks to enhance relationship functioning and prevent deterioration of relationship quality over time. However, impacts of CRE are mixed and often appear to be influenced by...
OBJECTIVE: Couple relationship education (CRE) seeks to enhance relationship functioning and prevent deterioration of relationship quality over time. However, impacts of CRE are mixed and often appear to be influenced by the characteristics of the couples receiving the intervention. To provide effective interventions, a better understanding of the couples who are most likely to benefit from CRE is needed. Unfortunately, the existing literature has failed to account for the complex and interdependent nature of pretreatment risk factors, leading to inconsistent and inconclusive results. METHOD: The present study addresses this issue by applying causal forest, a machine learning technique, to two randomized controlled trials of CRE to determine the pretreatment characteristics that are most predictive of treatment outcomes. In Study 1, data from 6,298 couples were used to train causal forest algorithms, and in Study 2, data from 1,595 couples were used to test the accuracy and generalizability of the trained models. RESULTS: Causal forest models indicated that pretreatment characteristics predicted 12-month treatment effects, such that participants with higher psychological distress and lower baseline relationship happiness experienced greater improvements in relationship happiness, while those with higher psychological distress and perceived stress had greater reductions in negative emotions and behaviors within the relationship. These results were robust when tested in a novel data set. CONCLUSIONS: This research highlights the underlying heterogeneity in CRE treatment effects and demonstrates the ability of machine learning methods to identify who may benefit most from CRE and can inform efforts to improve targeting of these interventions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Strengthening couple functioning to enhance child outcomes in low-income families: A randomized controlled trial.
Lavner JA, Chen PH, Williamson HC
J Consult Clin Psychol · 2026 Jan · PMID 41538202 · Publisher ↗
OBJECTIVE: Large-scale efforts have disseminated couple and relationship programs to strengthen couple relationships among low-income families, with the hope that doing so would yield benefits for partners and their chil...
OBJECTIVE: Large-scale efforts have disseminated couple and relationship programs to strengthen couple relationships among low-income families, with the hope that doing so would yield benefits for partners and their children. The present study provided a rigorous test of this hypothesis by examining indirect effects of a couple-focused preventive intervention on child outcomes in a large sample of low-income families. METHOD: Data were drawn from the Supporting Healthy Marriage evaluation, in which 6,298 low-income married couples with children were randomized to a relationship education intervention with supplemental activities and family support services or to a control condition. Couple relationship functioning was assessed 12 months postrandomization, and five child outcomes (self-regulation, internalizing behavior problems, externalizing behavior problems, cognitive and academic performance, and social competence) were assessed 30 months postrandomization. RESULTS: Structural equation models revealed that the intervention had significant indirect effects on children's self-regulation, internalizing behavior problems (children younger than 14 years), externalizing behavior problems (children younger than 14 years), cognitive and academic performance (children older than 5 years), and social competence, through enhanced couple functioning. CONCLUSIONS: Participation in a couple-focused intervention had significant indirect effects on low-income couples' children 30 months later through intervention-derived improvements in the couple relationship. These results suggest that strengthening couple relationships may be a viable option to indirectly promote child well-being in low-income families. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
What works for whom in outpatient cognitive-behavioral therapy? Integration of techniques from different therapeutic orientations and their interactions as predictors of treatment outcome in different diagnostic groups.
van Alebeek H, D'Errico L, Delgadillo J … +5 more , Dinger U, Ehrenthal JC, Pfannerstill F, Mander J, Probst T
J Consult Clin Psychol · 2026 Jan · PMID 41538201 · Publisher ↗
OBJECTIVE: The mechanisms underlying psychotherapy's effects remain debated, with some emphasizing theory-specific therapeutic techniques and others highlighting common factors like therapeutic alliance. Evidence is inco...
OBJECTIVE: The mechanisms underlying psychotherapy's effects remain debated, with some emphasizing theory-specific therapeutic techniques and others highlighting common factors like therapeutic alliance. Evidence is inconclusive partially because it is rarely assessed which interventions are actually employed in naturalistic outpatient settings. The study thus examined (a) how patient- and therapist-reported interventions during cognitive-behavioral therapy predict outcome, (b) whether naturally occurring integration of intervention from different therapeutic orientations predicts a more or less favorable outcome, and (c) whether the intervention-outcome association depends on specific diagnoses. METHOD: Using the Multitheoretical List of Therapeutic Interventions, 1,050 patients diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (Mage = 34.65, 58% female), and their 161 cognitive-behavioral therapy therapists reported which interventions were employed during psychotherapy. The patient-reported outcome, the Brief Symptom Checklist, was assessed at the beginning and end of therapy. RESULTS: Bayesian multilevel regression models revealed that patient-reported interventions were more consistently associated with the outcome than therapist-reported interventions. The person-centered subscale-especially reports on the exploration of personal meaning-emerged as the strongest predictor of the outcome. Integration of most interventions (i.e., reports on two subscales of the Multitheoretical List of Therapeutic Interventions) did not predict a more positive or negative outcome, though few combinations were beneficial. Findings regarding stronger intervention-outcome associations for specific diagnoses were not robust. CONCLUSION: By leveraging natural variability in routine clinical practice, this study provides insights into psychotherapy mechanisms beyond controlled trial constraints. It highlights the relevance of patients' perspective and the integration of interventions targeting meaning in predicting the outcome in outpatient cognitive-behavioral therapy. In addition, there seem to be no advantages nor adverse consequences of integrating therapeutic techniques. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Increasing the effectiveness of psychotherapy in routine care through transdiagnostic online modules? Randomized controlled trial investigating blended care.
Schaeuffele C, Mutak A, Behr S … +6 more , Fenski F, Hammelrath L, Puetz M, Pohl S, Knaevelsrud C, Boettcher J
J Consult Clin Psychol · 2026 Jan · PMID 41538200 · Publisher ↗
OBJECTIVE: Blended care (BC), the integration of Internet-based interventions into psychotherapy (PT), is thought of as a promising approach to enhance PT's effectiveness and efficiency. This randomized controlled trial...
OBJECTIVE: Blended care (BC), the integration of Internet-based interventions into psychotherapy (PT), is thought of as a promising approach to enhance PT's effectiveness and efficiency. This randomized controlled trial aimed to investigate the effectiveness as well as the implementation and usage of BC with transdiagnostic online modules compared to PT in routine care in Germany. Routine outpatient PT is delivered by licensed psychotherapists across different therapeutic orientations (cognitive behavioral therapy, psychodynamic, systemic), with variable treatment lengths and procedures. METHOD: Psychotherapists in routine outpatient care recruited 1,159 patients who were randomized to BC or PT. The primary outcome was self-reported mental distress (the composite of anxiety and depression); secondary outcomes included self-reported satisfaction with life, level of functioning, eating pathology, and drug and alcohol use, as well as therapist-rated severity and changes. Outcomes were measured at baseline, 6 weeks, 12 weeks, 6 months, and 12 months. We examined whether BC and PT groups changed differently over time using linear mixed models. We also investigated differences in sessions and terminations and report usage metrics of the BC platform. RESULTS: Contrary to our hypotheses, we did not find differences between BC and PT in outcomes, including anxiety, depression, satisfaction with life, level of functioning, eating pathology, alcohol and drug use, therapist-rated severity, and satisfaction with treatment at 6 months postrandomization (all p > .05). BC and PT did not differ in the number of sessions or terminations. Regarding usage of the BC platform, 534 patients (91.6%) received at least one online chapter, with M = 7.26 (SD = 7.01) of a total of 39 online chapters assigned on average, and patients logged in M = 19.73 (SD = 24.66) times and spent M = 367.14 (SD = 338.27) minutes on the platform. CONCLUSIONS: In this real-world application of BC, therapists had considerable flexibility in implementing BC and integrating Internet-based interventions with sessions. Our findings suggest that the benefits observed in more structured BC setups may not fully translate to a flexible and transdiagnostic BC setup in routine care, potentially due to variations in implementation and adherence. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Why are some cases not on track? An investigation of common obstacles and solutions during feedback-informed psychological therapy.
Williams E, Christensen H, Aguirre E … +4 more , Wheatley J, Corfe A, Thomson J, Delgadillo J
J Consult Clin Psychol · 2026 Jan · PMID 41538199 · Publisher ↗
OBJECTIVES: Using feedback helps to improve psychological treatment outcomes, particularly for patients whose symptom trajectory is not-on-track. However, little is known about why some cases are not-on-track and what st...
OBJECTIVES: Using feedback helps to improve psychological treatment outcomes, particularly for patients whose symptom trajectory is not-on-track. However, little is known about why some cases are not-on-track and what strategies can help to improve their treatment response. This study aimed to examine common obstacles and solutions identified by feedback-using therapists. METHOD: A cohort of therapists (N = 10) used a feedback algorithm that classified cases as on-track or not-on-track using session-by-session measures of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7). They followed a structured protocol to identify obstacles and potential solutions in not-on-track cases, and to document these using qualitative case notes. Case notes from 192 therapy sessions (across N = 44 cases) were analyzed using topic modeling, a machine learning approach to process qualitative data. RESULTS: Common obstacles were: (a) impact of traumatic experiences, (b) indicators of resistance, (c) social/interpersonal problems, (d) stressful life events, and (e) therapy process problems. Common solutions included: (a) strengthening agreement on goals and tasks, (b) enhancing focality, (c) individualized case formulation, and (d) enhancing expectations and motivation for change. CONCLUSIONS: Consistent with prior quantitative research, the topics identified in this qualitative study generally reflected problems related to motivation/resistance or interpersonal/relational problems. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The long-term effectiveness of psychodynamic and analytical psychotherapy in routine care: Results from a naturalistic study over 6 years.
Henkel M, Zimmermann J, Volz M … +3 more , Huber D, Staats H, Benecke C
J Consult Clin Psychol · 2025 Dec · PMID 41343390 · Publisher ↗
OBJECTIVE: This naturalistic study examines the long-term effectiveness of two psychoanalytically oriented therapies-psychodynamic psychotherapy (PP) and analytical psychotherapy (AP)-in routine care settings in Germany....
OBJECTIVE: This naturalistic study examines the long-term effectiveness of two psychoanalytically oriented therapies-psychodynamic psychotherapy (PP) and analytical psychotherapy (AP)-in routine care settings in Germany. METHOD: A total of 428 patients diagnosed with various mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, underwent treatment with either PP or AP. Diagnoses were reassessed at the end of treatment, and patients provided annual self-reports of their mental health over a 6-year period. We employed propensity score methods and piecewise linear latent growth curve models to estimate treatment effects on primary outcomes (i.e., number of diagnoses, symptom distress) and secondary outcomes (i.e., personality dysfunction, interpersonal problems, general life satisfaction). RESULTS: Patients exhibited substantial and sustained improvements across all outcomes in both treatments. Notably, those receiving AP experienced greater (long-term) improvement in primary and most secondary outcomes compared to those in PP. Improvements in PP primarily occurred during the 1st year, while AP patients continued to show progress throughout the entire observation period. For some outcomes (symptom distress, personality dysfunction, and interpersonal problems), AP was particularly effective for patients with more severe problems at baseline. CONCLUSIONS: Psychoanalytically oriented treatments in routine care are associated with substantial and lasting improvements, even posttreatment. Our findings highlight an incremental benefit of AP over PP, particularly for complex cases. Future research should explore treatment mechanisms, cost-effectiveness, and implications for health policy. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Emotion regulation as a transdiagnostic treatment construct across group cognitive behavioral therapies for adult anxiety and depression.
Reinholt N, Falkenström F, Eustis EH … +5 more , Hjorthøj C, Bryde A, Hvenegaard M, Arendt M, Arnfred SM
J Consult Clin Psychol · 2025 Dec · PMID 41196707 · Publisher ↗
OBJECTIVES: Identifying the mechanisms of change in first-line cognitive behavioral therapy (CBT) protocols for adult anxiety and depression could enhance outcomes for the individual. We explored (a) the effect of four g...
OBJECTIVES: Identifying the mechanisms of change in first-line cognitive behavioral therapy (CBT) protocols for adult anxiety and depression could enhance outcomes for the individual. We explored (a) the effect of four group CBT protocols on general emotion regulation skills, (b) the effect of specific emotion regulation skills on next-session symptom outcomes, and (c) the potential differences in these outcomes across the included protocols. METHOD: This secondary analysis used data from the TRACT-RCT trial investigating the relative efficacy of 14 sessions of transdiagnostic versus disorder-specific CBT group protocols for adult anxiety or depression ( = 291). We assessed the relative changes in general emotion regulation skills measured with the Emotion Regulation Skills Questionnaire at the end of treatment using multilevel modeling. We used cross-lagged panel modeling to test if changes in the use of five specific emotion regulation skills predicted changes in symptoms in the subsequent sessions, adjusting for depression/anxiety symptoms in the previous two sessions. Symptoms were assessed with the Overall Anxiety Severity and Impairment Scale and the Overall Depression Severity and Impairment Scale. RESULTS: Participants' general emotion regulation skills increased in the included CBT protocols, (2, 767.1) = 32.59, < .001. We found a significant cross-lagged effect of the emotion exposure skill on next-session symptoms (coefficient = -.25, 95% CI [-0.43, -0.07], = .005). The effects were similar across CBT protocols. CONCLUSIONS: This study used a rigorous methodology to identify emotion exposure as a relevant transdiagnostic and transtheoretical treatment outcome and a potential mechanism of change across group CBT protocols for adult anxiety and depression. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Questioning the distinction between active elements and mechanisms: Evidence from a reanalysis in cognitive behavioral therapy of depression.
Ezawa ID, Strunk DR
J Consult Clin Psychol · 2025 Dec · PMID 41196706 · Publisher ↗
OBJECTIVE: A new theoretical measurement framework for assessing active elements in cognitive behavioral therapies (CBT) emphasizes distinguishing various aspects of therapeutic components, and differentiating processes...
OBJECTIVE: A new theoretical measurement framework for assessing active elements in cognitive behavioral therapies (CBT) emphasizes distinguishing various aspects of therapeutic components, and differentiating processes occurring within and between sessions. In this article, we apply the framework to data analyzed prior to its introduction. METHOD: In Study 1, a panel of CBT experts evaluated items from the Cognitive Change scales (immediate and sustained) to determine whether they assess CBT skills (active elements) or cognitive change (mechanisms). In Study 2, we applied the framework to data from 125 CBT clients undergoing treatment for depression. Using disaggregated within- and between-patient components, we tested mediation models using framework-informed scores. RESULTS: In Study 1, experts achieved high interrater reliability and identified skill and cognitive change items using the framework. In Study 2, findings revealed that cognitive change mediated the relationship between skill use and symptom improvement. Results were similar using different subscales, consistent with the subscales being driven by a single underlying factor. CONCLUSIONS: Our results suggest that the pattern of findings was similar whether a distinction between skills and cognitive change was made or not. Considering previous factor analytic results and the present findings, we call into question whether the distinction between active elements and mechanisms is as essential or important as the framework suggests. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
The impact of routine outcome monitoring and feedback integration on treatment outcome: A therapist-specific indicator of belief updating processes?
Rubel JA, Peña Loray JS, Hehlmann MI … +3 more , Deisenhofer AK, Schwartz B, Lutz W
J Consult Clin Psychol · 2025 Dec · PMID 41196705 · Publisher ↗
OBJECTIVES: Therapists vary widely in their use of feedback, which may reflect differences in how they incorporate feedback into their clinical judgment-especially when their evaluations diverge from their patients'. Thi...
OBJECTIVES: Therapists vary widely in their use of feedback, which may reflect differences in how they incorporate feedback into their clinical judgment-especially when their evaluations diverge from their patients'. This process, often referred to as belief updating, involves adapting one's perspective based on new information and is thought to be a key mechanism underlying feedback effect on therapy outcomes. This study investigates whether therapists who align their ratings more closely with patient feedback-reflecting stronger integration and potential belief updating-benefit more from feedback. METHOD: Cross-lagged effects of patient (PR) and therapist (TR) symptom severity and well-being ratings were analyzed from 1,019 therapist-patient dyads (729 received feedback) using dynamic structural equation modeling. Feedback integration was operationalized as the cross-lagged relationship between PR and subsequent TR under feedback conditions compared to no feedback. RESULTS: PR were significantly associated with TR in the subsequent session. Feedback as a condition was not found to predict this cross-lagged association. Therapists showed significant variability (3.64%) regarding the association between PR and their own TR. Therapists' degree of feedback integration moderated the effect of feedback on patient outcomes under feedback conditions. CONCLUSIONS: Therapists who incorporated patient feedback benefited more from feedback interventions. This integration aligns with the belief updating process, hypothesized to be central to feedback effect. By adjusting their clinical judgments to reflect patient perspectives, therapists may improve treatment effectiveness. These findings emphasize the importance of therapist-specific factors and highlight how feedback and belief updating interact to shape therapeutic outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Dynamic prediction of inpatient self-harm and suicide attempts using machine learning: Toward data-driven clinical monitoring.
Kyron MJ, McCullough MH, Hooke GR … +9 more , Delgadillo J, Small M, Kyron D, Hehlmann M, Bryan CJ, Chen W, Hasking P, O'Connor RC, Page AC
J Consult Clin Psychol · 2025 Nov · PMID 41182708 · Publisher ↗
OBJECTIVE: Self-harm and suicide attempts are notoriously difficult to predict and to prevent, particularly as they are low base-rate events. This study aimed to improve prediction by combining static information-unchang...
OBJECTIVE: Self-harm and suicide attempts are notoriously difficult to predict and to prevent, particularly as they are low base-rate events. This study aimed to improve prediction by combining static information-unchanging patient characteristics collected at admission-with dynamic self-reported mental health data collected daily during inpatient care. METHOD: Seventeen thousand five hundred eight psychiatric inpatients self-reported their mental health daily throughout their hospital stay (Mage = 40.72, female = 71%). Machine-learning models predicted self-harm over the next 7-days, which made new risk projections daily based on available self-report data. Prediction was compared between models that used only static information and those that included daily-updated information. RESULTS: The dynamic daily-updated prediction model exhibited stable prediction performance over time, while the static model reliant on information collected at admission decreased over time. Although all models performed well in detecting events, the rate of false positives increased substantially over time in static models (excluding daily data), and model accuracy tended to decrease. CONCLUSIONS: The improved performance of prediction models leveraging dynamic (daily) self-reported data could support just-in-time alerts for clinical staff. Further research is needed to identify salient markers for when the risk of self-harm and suicide attempts may be heightened to further enhance prediction accuracy. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Dynamic and dyadic relationships between facial behavior, working alliance, and treatment outcomes during depression therapy.
Girard JM, Yermol DA, Bylsma LM … +4 more , Cohn JF, Fournier JC, Morency LP, Swartz HA
J Consult Clin Psychol · 2025 Nov · PMID 41182707 · Full text
OBJECTIVE: Previous work has yielded mixed results regarding the relationships of interpersonal synchrony with working alliance and treatment outcomes. We sought to clarify these relationships by applying more sophistica...
OBJECTIVE: Previous work has yielded mixed results regarding the relationships of interpersonal synchrony with working alliance and treatment outcomes. We sought to clarify these relationships by applying more sophisticated dynamic and dyadic methods. METHOD: Adult outpatients with depression (N = 65, age 18-64, 65% female, 68% White) participated in up to eight sessions of cognitive behavioral or interpersonal psychotherapy. Sessions occurred either in person or via teletherapy and were video-recorded. Facial computing tools estimated the momentary intensity of patients' and therapists' scowling and smiling, and the interpersonal synchrony of these measures during each session was quantified using windowed cross-correlation analyses. Hypotheses about within-dyad processes (i.e., session-to-session changes) and between-dyad associations (i.e., of average tendencies) were tested using hierarchical Bayesian mediation models. RESULTS: Numerous and nuanced associations were found between facial behavior, working alliance, and treatment outcomes (e.g., session-to-session increases in patient-rated working alliance were predicted by higher than average therapist smiling). Interpersonal synchrony did not predict within-dyad changes in working alliance or depression symptoms; however, on the between-dyad level, higher average patient-rated working alliance was predicted by both higher average smile synchrony and lower average scowl synchrony. CONCLUSIONS: The facial behavior of patients and therapists provides a valuable window into the therapeutic process, especially with regard to the alliance. Contributions come from the behaviors of each person as well as their level of interpersonal synchrony. However, contrary to extant theories, the associations of synchrony with working alliance and outcomes depend on the behavior being synchronized, the informant providing ratings, and the level of analysis being conducted. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Between- and within-person relations between treatment modules and symptom improvements across six randomized controlled trials.
Venturo-Conerly KE, Mair P, Webb C … +4 more , Hill E, Chorpita BF, Merry SN, Weisz JR
J Consult Clin Psychol · 2025 Nov · PMID 41182706 · Publisher ↗
OBJECTIVE: Most youth psychotherapies contain multiple treatment elements; little is known about their relative effectiveness. We assessed symptom improvements associated with treatment elements, represented by modules w...
OBJECTIVE: Most youth psychotherapies contain multiple treatment elements; little is known about their relative effectiveness. We assessed symptom improvements associated with treatment elements, represented by modules within modular psychotherapy. METHOD: Data from six clinical trials of the modular approach to therapy for children with anxiety, depression, trauma, or conduct problems modular psychotherapy were combined (N = 490; 5,403 sessions; 6-15 years) to test effects of modules grouped into seven common treatment principles: feeling calm (e.g., relaxation strategies), increasing motivation (e.g., contingency management), repairing thoughts (e.g., cognitive restructuring), solving problems (e.g., problem solving), trying the opposite (e.g., exposure), engagement/psychoeducation (e.g., building rapport), and future planning (e.g., planning skill use). Multilevel models with autoregressive covariance controlled for previous symptoms, session number, and baseline symptoms; accounted for temporality with each session occurring prior to associated outcomes; importantly, we modeled associations between outcomes and between- and within-person use of treatment principles. Measures included weekly youth- and caregiver-reported internalizing, externalizing, and total symptoms, plus idiographic top problems. RESULTS: A between-person effect linked future planning (Bs = -.369 to -.368; ps < .05) to better outcomes. Better within-person effects were observed for increasing motivation (Bs = -0.087 to -0.057; ps < .05), trying the opposite (Bs = -.087 to -.056; ps < .05), and future planning (B = -0.146; p < .001). Six outcomes showed worse within-person effects for engagement/psychoeducation (Bs = .036-.099; ps < .05); efforts to build engagement drove this finding; those efforts were associated with less use of skills-focused principles. CONCLUSIONS: Increasing motivation, trying the opposite, and future planning were associated with especially good outcomes; therapists' engagement attempts were associated with less focus on skill building and poorer immediate outcomes. Results may inform youth psychotherapy decision-making research and practice. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Is there a treatment for the Turker blues? A fully remote nationwide randomized controlled trial of a digital intervention for depression in adult online workers.
Peipert A, Lorenzo-Luaces L
J Consult Clin Psychol · 2025 Nov · PMID 41182705 · Publisher ↗
OBJECTIVE: We conducted a nationwide, fully remote two-arm randomized controlled trial to test the efficacy of a self-guided internet-based behavioral activation (BA) intervention for depression in online workers. The in...
OBJECTIVE: We conducted a nationwide, fully remote two-arm randomized controlled trial to test the efficacy of a self-guided internet-based behavioral activation (BA) intervention for depression in online workers. The intervention was a 4-week program designed as part of the Common Element Toolbox (COMET). METHOD: Eight hundred five online workers who screened for depression were randomized to COMET-BA or a wait-list control. Self-report measures of depression, anxiety, subjective well-being, BA, psychosocial function, and emotion regulation were collected weekly for 4 weeks, 1-week postintervention, and then at a 1-month follow-up. The design and analytic plan were preregistered. RESULTS: There was a significant Time × Treatment interaction during the intervention phase of the study. Those in COMET-BA improved significantly more than those in the wait-list control, with small-medium differences in depression (standardized mean difference = -0.32; 95% CI [-0.47, -0.17]). All but two outcomes demonstrated significant improvements, which were maintained during the 1-month follow-up period. CONCLUSION: BA may be effectively delivered as a self-guided online intervention for depression in online workers. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
The quasi-experimental multiple baseline panel design: A suitable design for psychotherapy outcome research in clinical practice.
Falkenström F, Fjällström R, Bengtsson D
J Consult Clin Psychol · 2025 Dec · PMID 41166212 · Publisher ↗
OBJECTIVE: While randomized clinical trials offer high internal validity, their generalizability to real-world practice is often limited due to ethical and/or legal problems with experimental manipulations, especially th...
OBJECTIVE: While randomized clinical trials offer high internal validity, their generalizability to real-world practice is often limited due to ethical and/or legal problems with experimental manipulations, especially the assignment of participants to waiting lists or placebo conditions. The quasi-experimental multiple baseline panel design (QE-MBPD) is introduced as a viable alternative to randomized clinical trials for evaluating psychotherapy outcomes in routine clinical settings. METHOD: The QE-MBPD adapts the traditional single-subject multiple baseline design to larger groups, thereby increasing possibilities for statistical analysis and generalizability. In the quasi-experimental version proposed, natural variation in clinic waiting times is utilized to establish varying baseline lengths, which is crucial for the internal validity of the design. RESULTS: The article outlines the principles, applications, advantages, and limitations of the QE-MBPD, emphasizing its potential to bridge the gap between academic research and regular clinical practice. An ongoing empirical study in Swedish community-based psychiatric care is used to demonstrate the design's effectiveness and versatility. We also explore the potential of QE-MBPD to enhance routine outcome monitoring systems by using deviations from the projected trend, established during the baseline phase, as criteria for determining when feedback should be provided during the treatment phase. CONCLUSIONS: Despite the strengths of the QE-MBPD, the reliance on a waiting-list phase as control condition is a principal limitation, similar to what has been argued in randomized clinical trials. There is a need for further research to fully establish the strengths and weaknesses of this design in advancing evidence-based psychotherapy practice. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
A randomized controlled trial comparing two processes of exposure therapy: Extinction learning and habituation.
Treanor M, Zbozinek TD, Rosenberg BM … +4 more , Sewart A, Sandman CF, Ruiz J, Craske MG
J Consult Clin Psychol · 2025 Oct · PMID 41129370 · Publisher ↗
OBJECTIVE: To investigate the role of extinction learning and habituation by comparing inhibitory retrieval to habituation-focused exposure for social anxiety and panic disorder. METHOD: In this assessor-blinded, paralle...
OBJECTIVE: To investigate the role of extinction learning and habituation by comparing inhibitory retrieval to habituation-focused exposure for social anxiety and panic disorder. METHOD: In this assessor-blinded, parallel-group, two-arm randomized controlled clinical superiority trial, 89 treatment-seeking adults with social anxiety (n = 77) or panic disorder (n = 12) received nine weekly therapy sessions of inhibitory retrieval or habituation-focused exposure therapy. Outcomes were client-reported symptoms, interviewer-rated client distress and impairment, and a behavioral approach task. RESULTS: Modified intent-to-treat analyses were conducted using multilevel modeling. There were no group differences on principal outcomes of interviewer-rated distress and impairment, nor significant pairwise differences on symptom scores at posttreatment or follow-up (ps > .11). However, secondary and exploratory analyses revealed that relative to the habituation condition, participants in the inhibitory retrieval condition demonstrated significantly steeper decreases in self-reported anxiety from baseline to posttreatment, b = 0.05, 95% CI [0.01, 0.08], χ2(1) = 6.67, p = .010; session-by-session self-reported anxiety, b = 0.01, 95% CI [0.004, 0.02], χ2(1) = 12.33, p = .001; and distress during a behavioral approach task, f = .134, χ2(1) = 4.75, p = .029. Additionally, a higher percentage of participants in the inhibitory condition achieved clinically significant change on self-reported anxiety at posttreatment (43% vs. 13%), although there were no group differences on interviewer-rated indices of clinically significant change (ps > .42). CONCLUSION: Both methods of exposure therapy were effective. Exposure therapy targeting extinction learning modestly improved outcomes on secondary and exploratory measures although, aside from reliable and clinically significant change, group differences at posttreatment and follow-up were not significant. Habituation-focused exposure therapy was not superior on any measure. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Pilot microrandomized trial of a brief digital intervention for suicidal thoughts.
Bentley KH, Ball MI, Bose S … +8 more , Fortgang RG, Coppersmith DDL, DeMarco D, Hu N, Herrmann F, Daniel M, Dempsey W, Nock MK
J Consult Clin Psychol · 2025 Oct · PMID 41129369 · Full text
OBJECTIVE: The goal of this study was to conduct a pilot microrandomized trial to assess the feasibility and acceptability of a brief digital intervention aimed at promoting in-the-moment coping strategy use for suicidal...
OBJECTIVE: The goal of this study was to conduct a pilot microrandomized trial to assess the feasibility and acceptability of a brief digital intervention aimed at promoting in-the-moment coping strategy use for suicidal thoughts after psychiatric hospitalization. METHOD: Seventy-one adults hospitalized for suicide risk (Mage = 31.94 years, 46.48% female, 78.87% White) were enrolled and included in analyses. Real-time reports of suicidal thoughts were collected for 28 days after discharge via ecological momentary assessment. Each time participants reported an elevated momentary suicide urge or intent on an ecological momentary assessment survey, they were randomized to smartphone-based messages aimed at promoting the use of evidence-based coping strategies (vs. "no message" control). Messages included either personalized or general coping strategy recommendations. RESULTS: Forty-four participants (57.89%) met criteria for randomization at least once and were randomized on average 11.48 times (SD = 23.38); 8.85% of completed ecological momentary assessments met randomization criteria. Participants found the intervention messages feasible and acceptable. Most described the messages as helpful and preferred personalized (over general) messages. Statistical analyses revealed no group-level iatrogenic intervention effects. Following intervention (vs. no intervention), participants were significantly more likely to report use of a coping strategy to manage suicidal thoughts, with stronger effects for personalized messages. CONCLUSIONS: This pilot microrandomized trial supports the feasibility and acceptability of a brief digital intervention for promoting in-the-moment coping strategy use during episodes of suicidal thinking. Results inform the development of novel just-in-time adaptive interventions for suicide prevention and the design of larger-scale microrandomized trials to evaluate and optimize them. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Ethnicity and income as predictors of clinical outcomes of a youth-focused personalizable modular treatment.
Cho E, Chorpita BF, Reeder K … +4 more , Alegría M, Price MA, Weisz JR, Research Network on Youth Mental Health
J Consult Clin Psychol · 2025 Oct · PMID 41129368 · Publisher ↗
OBJECTIVE: Personalizable modular treatments may be helpful in addressing the mental health needs of minoritized youths. We used data from five randomized effectiveness trials of the Modular Approach to Therapy for Child...
OBJECTIVE: Personalizable modular treatments may be helpful in addressing the mental health needs of minoritized youths. We used data from five randomized effectiveness trials of the Modular Approach to Therapy for Children, a personalizable, individually tailored, modular treatment for common youth mental health concerns, to investigate whether clinical outcomes were predicted by ethnicity, family income, and their interaction. METHOD: Participants were drawn from a pool of 537 clinically referred youths treated for internalizing and/or externalizing problems in community clinics and their caregivers. The mean youth age was 9.97 (SD = 2.59); 57% were male; 49% were White, 22% Hispanic or Latinx, 14% Black, 13% multiethnic, 1% Asian, and 1% other ethnicity. Family income ranged from 21% to 776% of the federal poverty threshold, with 38% below the threshold. Youths and caregivers completed standardized measures of internalizing and externalizing problems quarterly for up to 24 months and standardized measures of internalizing and externalizing problems and idiographic top problem severity weekly throughout treatment. RESULTS: Following adjustment for multiple analyses, ethnicity, income, and their interaction did not predict symptom improvement on any youth or caregiver-reported outcomes. CONCLUSIONS: Youths treated with the Modular Approach to Therapy for Children experienced comparable clinical benefits across ethnic groups and income levels, with no predictor effects when the number of tests was controlled for. The findings support future research on personalizable modular treatment for minoritized youths. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Exploring the influence of loneliness and social isolation in transdiagnostic internet-delivered cognitive behavioral therapy for depression and anxiety.
Käll A, Sapkota RP, Gretton A … +6 more , Wilhelms A, Nugent M, Andersson G, Dear B, Titov N, Hadjistavropoulos HD
J Consult Clin Psychol · 2025 Oct · PMID 41129367 · Publisher ↗
OBJECTIVE: Past research shows that social factors play an important role in mental health outcomes, but there is limited research on how these factors influence Internet-delivered cognitive behavior therapy (ICBT). This...
OBJECTIVE: Past research shows that social factors play an important role in mental health outcomes, but there is limited research on how these factors influence Internet-delivered cognitive behavior therapy (ICBT). This study investigated the prevalence of subjective (i.e., feelings of loneliness) and objective social isolation among patients receiving transdiagnostic ICBT. We explored whether social factors change over treatment and moderate treatment effectiveness and engagement. METHOD: This study used data collected in a routine ICBT clinic. Among clients with elevated depression and/or anxiety who started ICBT (n = 625), we analyzed measures of depression, anxiety, loneliness, and social engagement administered at pretreatment, various points during the treatment and 20 weeks follow-up. RESULTS: Pretreatment prevalence of frequent loneliness and social isolation was 75.7% and 54.6%, respectively. Depression and anxiety decreased over time, with large effect sizes from pretreatment to follow-up (depression d = 1.56; anxiety d = 1.63). Loneliness decreased significantly (d = 0.69), while social engagement improved moderately (d = 0.37). Higher pretreatment loneliness was associated with higher average levels of depression across the treatment period and with fewer completed treatment lessons. CONCLUSIONS: Overall, results indicate that loneliness and social isolation are prevalent among clients seeking ICBT and both decrease during transdiagnostic ICBT. More frequent loneliness during the treatment was associated with lower engagement and smaller treatment gains, while social isolation was not. These findings suggest that further research is warranted on how to address loneliness within ICBT. It also suggests that social isolation can be reduced by means of transdiagnostic ICBT. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Why we need effective deimplementation strategies to reduce the costs by ineffective and potentially harmful therapies.
Herzog P, McLean CP
J Consult Clin Psychol · 2025 Oct · PMID 41129366 · Publisher ↗
The provision of unsupported, proven ineffective, and potentially harmful therapies is a persistent problem in mental health care. Multiple reasons at the provider, system/policy, and public levels can help explain why p...
The provision of unsupported, proven ineffective, and potentially harmful therapies is a persistent problem in mental health care. Multiple reasons at the provider, system/policy, and public levels can help explain why practitioners are drawn to use poorly supported and pseudoscientific treatments. The example of posttraumatic stress disorder demonstrates how past attempts to implement evidence-based practice have failed, underlining the limits of an overly strong focus on traditional implementation strategies. This continuing science-practice gap comes at a cost not only for the individual but also for society, thereby wasting valuable resources and reducing their public health impact. Proceeding in parallel with implementation efforts to increase access to well-supported treatment, implementation science must also develop and deploy deimplementation strategies to tackle this challenge. Deimplementation science studies methods to systematically remove non-evidence-based practices from routine clinical care. The longitudinal prescription practice trend for posttraumatic stress disorder medication showed the benefits of targeted deimplementation efforts (e.g., reducing medication overprescription), but there is less evidence for successfully deimplementing psychological therapies. To fill this research gap, we propose a potential deimplementation framework targeting low-value and inappropriate care. Prioritizing deimplementation (e.g., removing ineffective and harmful treatments) may prevent wasting resources in research and health care, thereby exerting a public health impact equally large as the uptake of evidence-based innovations. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
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