J Consult Clin Psychol [JOURNAL]
Sun
200 papers
Telehealth-delivered depression prevention: Short-term outcomes from a school-based randomized controlled trial.
Young JF, Jones JD, Schwartz KTG … +6 more , So A, Dysart GC, Kanine RM, Gillham JE, Gallop R, Davis M
J Consult Clin Psychol · 2025 Apr · PMID 39480285 · Publisher ↗
OBJECTIVE: To examine short-term (i.e., postintervention) outcomes from a randomized controlled trial comparing a school-based telehealth-delivered depression prevention program, Interpersonal Psychotherapy-Adolescent Sk...
OBJECTIVE: To examine short-term (i.e., postintervention) outcomes from a randomized controlled trial comparing a school-based telehealth-delivered depression prevention program, Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), to services as usual (SAU). We expected IPT-AST would be acceptable and feasible and that IPT-AST adolescents would experience greater reductions in depression symptoms, anxiety symptoms, and impairment compared with SAU. METHOD: Adolescents ( = 242; = 14.80 years, = 0.70; 65% female; 21% Black; 13% Hispanic/Latinx) with elevated scores on the Center for Epidemiologic Studies Depression Scale (Radloff, 1977) at screening provided data at baseline, 2-month (midpoint of IPT-AST), and 3-month (postintervention) assessments. They reported depression symptoms on the Center for Epidemiologic Studies Depression Scale, anxiety symptoms on the Screen for Child Anxiety Related Emotional Disorders (Birmaher et al., 1997), and impairment on the Columbia Impairment Scale (Bird et al., 1993). Baseline depression diagnosis was examined as a moderator. RESULTS: Hierarchical linear models showed that adolescents reported significant reductions in depression symptoms and impairment across conditions. IPT-AST adolescents reported significantly greater reductions in anxiety symptoms than SAU adolescents, = .39, 95% CI [.05, .72], = .003. Depression diagnosis moderated outcomes (s = .33-.34, s ≤ .05), such that IPT-AST adolescents without a diagnosis at baseline showed greater improvements in depression and anxiety symptoms than SAU adolescents. Adolescents in SAU with a depression diagnosis at baseline showed greater improvements in impairment compared with IPT-AST. Attendance and satisfaction data demonstrated the feasibility and acceptability of telehealth-delivered IPT-AST. CONCLUSIONS: Results support telehealth-delivered IPT-AST as a promising intervention for improving short-term outcomes among adolescents with depression symptoms but without a depression diagnosis. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Results of a randomized waitlist-controlled trial of online cognitive behavioral sex therapy and online mindfulness-based sex therapy for hypoactive sexual desire dysfunction in women.
Velten J, Hirschfeld G, Meyers M … +1 more , Margraf J
J Consult Clin Psychol · 2024 Nov · PMID 39446648 · Publisher ↗
OBJECTIVE: This study aimed to investigate the efficacy of two internet-delivered psychological treatments for hypoactive sexual desire dysfunction (HSDD) in women: internet-based cognitive behavioral sex therapy (iCBST)...
OBJECTIVE: This study aimed to investigate the efficacy of two internet-delivered psychological treatments for hypoactive sexual desire dysfunction (HSDD) in women: internet-based cognitive behavioral sex therapy (iCBST) and internet-based mindfulness-based sex therapy (iMBST). METHOD: Women with HSDD were randomly assigned to one of three groups: iCBST, iMBST, or a waitlist control group. The interventions consisted of eight modules delivered via an e-health platform with e-coach support to enhance adherence. Sexual desire and sexual distress were assessed at baseline and at 3-, 6-, and 12-month follow-ups (active conditions only). Per protocol, of the 266 consenting women, 106 were randomized to iCBST ( = 36.1, = 10.3), 106 to iMBST ( = 36.4, = 0.2), and 54 to the control condition ( = 36.7, = 11.0). Primary analyses utilized an intention-to-treat approach with linear mixed models. Clinical significance, assessed with clinical cutoffs and the reliable change index, was examined for active conditions. RESULTS: Compared to the control condition, both iCBST and iMBST demonstrated significant improvements in sexual desire and sexual distress at 3-month ( = 0.89-1.14) and 6-month follow-up ( = 0.74-1.18). Results were sustained at 12-month follow-up, with 35 and 41% demonstrating reliable improvements and additional 20 and 24% achieving clinically significant improvements in sexual desire after iCBST and iMBST. Regarding sexual distress, 49 and 42% exhibited reliable change, with an additional 37%-42% achieving clinically significant improvements. CONCLUSIONS: Results provide support for the overall long-term efficacy of psychological therapies in treating HSDD in women. However, fewer than one in four women showed improvements in sexual desire that met the threshold for clinically significant change. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Safety behavior reduction for appearance concerns: A randomized controlled trial of a smartphone-based intervention.
Patel TA, Cougle JR
J Consult Clin Psychol · 2024 Dec · PMID 39446647 · Publisher ↗
OBJECTIVE: Appearance concerns are a core feature of multiple psychiatric disorders (i.e., body dysmorphic disorder, eating disorders, and social anxiety disorders). Individuals with these concerns commonly engage in app...
OBJECTIVE: Appearance concerns are a core feature of multiple psychiatric disorders (i.e., body dysmorphic disorder, eating disorders, and social anxiety disorders). Individuals with these concerns commonly engage in appearance-related safety behaviors (ARSB), behaviors intended to avoid, prevent, or manage the negative evaluation of one's physical appearance. The present study evaluated a brief ARSB reduction intervention for appearance concerns. METHOD: Women with elevated appearance concerns ( = 203) were recruited from across the United States and randomized to receive one of two 1-month smartphone-based interventions targeting ARSBs or unhealthy behaviors (UHBs). Both consisted of daily text messages with links to behavior checklists and reminders to avoid the respective behaviors. RESULTS: Participants in both treatments saw substantial reductions in symptoms. Though the UHB fading condition showed significantly better treatment adherence than ARSB fading, ARSB fading led to significantly lower appearance concerns (² = .028, = .014) and eating disorder symptoms (² = .024, = .020) at posttreatment, and lower appearance concerns (² = .041, = .004), eating disorder symptoms (² = .029, = .006), social anxiety (² = .048, = .005), and appearance importance at 1-month follow-up (² = .042, = .011), relative to UHB fading. Changes in ARSBs were found to partially mediate the effect of treatment on appearance concerns. CONCLUSIONS: These preliminary findings provide novel evidence for the efficacy of targeting ARSBs and suggest that this text-based intervention may be an efficacious and accessible intervention for women with elevated appearance concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Disentangling between- and within-patients effects of emotion regulation on outcome in naturalistic psychotherapy.
Fernández-Álvarez J, Babl A, Botella C … +2 more , Grosse Holtforth M, Gómez Penedo JM
J Consult Clin Psychol · 2024 Sep · PMID 39418461 · Publisher ↗
OBJECTIVE: The aim of this study was to disaggregate the between-patient and within-patient effects of emotion regulation (ER) on treatment outcome and explore relevant trait-like moderators of the within-patient effects...
OBJECTIVE: The aim of this study was to disaggregate the between-patient and within-patient effects of emotion regulation (ER) on treatment outcome and explore relevant trait-like moderators of the within-patient effects. METHOD: Three hundred thirty-nine patients with heterogenous clinical conditions were admitted to psychotherapy at a clinical center. During the intake evaluation, patients completed the Inventory of Interpersonal Problems, the Outcome Questionnaire 30, and the State Difficulties of Emotion Regulation Scale. Subsequently, patients responded to the Outcome Questionnaire 30 and State Difficulties of Emotion Regulation Scale every session for the initial five sessions, followed by assessments every two sessions until the 15th session and then every four sessions until the end of treatment. RESULTS: Multilevel models revealed significant between- and within-patient effects of ER on clinical distress. That is, patients with lower average levels of ER difficulties showed greater benefit from treatment, and lower ER difficulties over the course of treatment were associated with lower clinical distress. Furthermore, interactive models demonstrated that lower average levels of ER throughout treatment and fewer interpersonal problems at the beginning of treatment were associated with better treatment outcome. CONCLUSION: These findings provide evidence supporting the role of ER as a mechanism of change. The interaction between trait-like components and state-like fluctuations of ER suggests a capitalization model for the role of ER in psychotherapy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Reciprocal relationships between posttraumatic stress disorder symptoms and positive and negative affect in evidence-based treatments for posttraumatic stress disorder.
Rosencrans PL, Walker RSW, Coyne AE … +6 more , Baier AL, Klein AB, Shekhtman K, Bowling AR, Feeny NC, Zoellner LA
J Consult Clin Psychol · 2024 Sep · PMID 39418460 · Publisher ↗
OBJECTIVE: Posttraumatic stress disorder (PTSD) is associated with elevated negative affect (NA; e.g., Badour et al., 2017) and diminished positive affect (PA; Nawijn et al., 2015). PTSD treatments reduce NA (e.g., Jerud...
OBJECTIVE: Posttraumatic stress disorder (PTSD) is associated with elevated negative affect (NA; e.g., Badour et al., 2017) and diminished positive affect (PA; Nawijn et al., 2015). PTSD treatments reduce NA (e.g., Jerud et al., 2014), but changes in PA and relationships between changes in affect and PTSD symptoms remain unclear. METHOD: This study examined changes in PA and NA in adults (N = 130) with PTSD receiving prolonged exposure (PE) or PE plus sertraline as part of a randomized controlled trial (NCT01600456). Participants completed measures of affect (PANAS; Watson et al., 1988) and PTSD symptoms at 10 weekly treatment sessions. Cross-lagged dynamic structural equation models examined associations between session-to-session fluctuations in affect and PTSD. RESULTS: PA increased moderately (d = 0.51) and NA decreased strongly (d = 0.78) across treatment sessions. Within-person fluctuations in PA and NA were generally reciprocal, PAt → NAt+1: effect size (ES) = -0.09, 95% CI [-0.15, -0.02]; NAt → PAt+1: ES = -0.20, 95% CI [-0.28, -0.13]. However, fluctuations in PTSD more strongly predicted next session NA (PTSDt → NAt+1: ES = 0.50, 95% CI [0.38, 0.60]) and PA (PTSDt → PAt+1: ES = -0.26, 95% CI [-0.34, -0.17]) than the reverse. PE augmentation with a selective serotonin reuptake inhibitor did not moderate temporal associations. CONCLUSIONS: Prolonged exposure produced substantial improvements in PA and NA. General affective changes may be more a consequence than a driver of PTSD improvement during PE, with improvements in NA and PA potentially linked to the extinction of negative emotional responses to trauma cues and increased engagement with rewarding activities, respectively. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Does mindfulness-based cognitive therapy with tapering support reduce risk of relapse/recurrence in major depressive disorder by enhancing positive affect? A secondary analysis of the PREVENT trial.
Dunn BD, Warbrick L, Hayes R … +4 more , Montero-Marin J, Reed N, Dalgleish T, Kuyken W
J Consult Clin Psychol · 2024 Sep · PMID 39418459 · Publisher ↗
OBJECTIVE: Mindfulness-based cognitive therapy (MBCT) is a viable alternative to maintenance antidepressant medication (M-ADM) to reduce risk of relapse/recurrence (RR) in recurrent depression, but its mechanism of actio...
OBJECTIVE: Mindfulness-based cognitive therapy (MBCT) is a viable alternative to maintenance antidepressant medication (M-ADM) to reduce risk of relapse/recurrence (RR) in recurrent depression, but its mechanism of action is not yet fully articulated. This secondary analysis of the PREVENT trial examined if MBCT with support to taper medication (MBCT-TS) reduces risk of RR in part by enhancing positive affect (PA). METHOD: In a single-blind, parallel, group randomized controlled trial, adults with ≥3 prior depressive episodes, but not currently in episode and who were taking M-ADM, were randomized to receive either MBCT-TS or ongoing maintenance M-ADM. The primary outcome was RR over 24-month follow-up. Levels of positive affect were assessed at intake and posttreatment. The original PREVENT trial was preregistered (ISRCTN 26666654), but this secondary analysis was not. RESULTS: Four hundred and twenty-four individuals (predominantly female and of White British ethnicity) were recruited, with 212 randomized to each arm. MBCT-TS led to significantly greater PA relative to M-ADM at posttreatment assessment (Δ = 2.78, 95% CI [1.47, 4.08], p < .001). RR was experienced during follow-up by 194 individuals (100 M-ADM; 94 MBCT-TS). Greater intake PA predicted a reduced hazard of RR across treatments (p < .001; hazard ratio = .96, 95% CI [0.94, 0.98]). In individuals who had not relapsed by posttreatment with complete data (121 M-ADM; 145 MBCT-TS), greater increase in PA from intake to posttreatment mediated reduced risk of subsequent RR (p = .04). CONCLUSIONS: These findings suggest that greater levels of PA predict reduced risk of RR and that MBCT-TS in part acts to protect from RR when withdrawing from M-ADM by increasing PA. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Emotions observed during sessions of dialectical behavior therapy predict outcome for borderline personality disorder.
Nardone S, Pascual-Leone A, Kramer U … +4 more , Cristoffanini F, Grandjean L, Culina I, McMain S
J Consult Clin Psychol · 2024 Sep · PMID 39418458 · Publisher ↗
OBJECTIVE: We examined whether the emotions that clients experience within session are associated with treatment outcome in dialectical behavior therapy (DBT) for borderline personality disorder (BPD). METHOD: Participan...
OBJECTIVE: We examined whether the emotions that clients experience within session are associated with treatment outcome in dialectical behavior therapy (DBT) for borderline personality disorder (BPD). METHOD: Participants were 52 adults who met criteria for BPD and were enrolled in a 12-month DBT treatment. The Classification of Affective-Meaning States, an observer-rated measure of discrete emotions, was used to code videos of individual DBT sessions. Raters coded three psychotherapy sessions for each participant: one session from each of the early, working, and late phases of psychotherapy. Self-report measures of BPD symptoms were used to assess treatment outcome. RESULTS: More emotional experience overall during the early phase predicted fewer BPD symptoms at 12-month treatment outcome, explaining 19% of the variance in symptoms. However, increases across treatment in global distress predicted higher levels of BPD (24% of the variance explained) and depression symptoms (15% explained) at termination. Increases in emotional flexibility (i.e., variation between states) from the early to working phase predicted fewer depressive symptoms at termination (14% explained). Self-compassion coded during the working phase also predicted a better treatment outcome (explaining 19%-34%). CONCLUSIONS: Clients' in-session emotional experiences predict treatment outcome 8-10 months later. Clients with BPD may benefit from more overall exploration of their emotional experiences early in DBT, as well as expression of self-compassion. Increases in nonspecific, intense negative affect anticipates poor prognosis, whereas increases in emotional flexibility during early treatment anticipates better prognosis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Individualized Assessment and Treatment Program (IATP) for alcohol use disorder: Comparison with conventional cognitive-behavioral treatment and examination of coping skills as a mediator of treatment.
Litt MD, Tennen H, Kadden RM
J Consult Clin Psychol · 2024 Oct · PMID 39374130 · Full text
OBJECTIVE: This study tested a highly individualized cognitive-behavioral coping skills treatment for alcohol use disorder (AUD). Recent studies have indicated that coping skills training programs are not always effectiv...
OBJECTIVE: This study tested a highly individualized cognitive-behavioral coping skills treatment for alcohol use disorder (AUD). Recent studies have indicated that coping skills training programs are not always effective. A possible explanation is that the training provided in these programs may not address the specific needs of the patient. The Individualized Assessment and Treatment Program (IATP) was intended to provide a highly individualized approach to the training of skills most relevant for each individual. METHOD: Men and women with AUD ( = 173) were randomly assigned to one of three, manualized, 12-session treatments: IATP, a conventional (Packaged) cognitive-behavioral program (PCBT), or a Case Management control condition (CaseM). An experience sampling (ES) procedure was employed prior to, and during, treatment to record alcohol use and coping behaviors in all patients. In IATP, this information was used by therapists to plan treatment that would address the specific strengths and weaknesses of each patient in alcohol-use situations. ES data were collected at multiple time points and patients were followed every 3 months out to 21 months posttreatment. RESULTS: Multilevel model analyses indicated that IATP yielded better drinking outcomes than the CaseM or PCBT conditions. Mediation analyses indicated that the effects of IATP versus the other treatments on outcomes were accounted for at least partly by changes in active coping with high-risk situations. CONCLUSION: Due to the limited diversity of the sample, generalizability of the results may be limited. Results are discussed in terms of the importance of tailoring treatment for the individual patient. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Does it matter how meditation feels? An experience sampling study.
Goldberg SB, Bolt DM, Dahl CJ … +2 more , Davidson RJ, Hirshberg MJ
J Consult Clin Psychol · 2024 Aug · PMID 39347788 · Full text
OBJECTIVE: Meditation apps are the most widely used mental health apps. The precise mechanisms underlying their effects remain unclear. In particular, the degree to which affect experienced during meditation is associate...
OBJECTIVE: Meditation apps are the most widely used mental health apps. The precise mechanisms underlying their effects remain unclear. In particular, the degree to which affect experienced during meditation is associated with outcomes has not been established. METHOD: We used the meditation app arm of a recently completed randomized controlled trial comparing a self-guided meditation app (Healthy Minds Program) to a waitlist control. Predominantly distressed public school employees ( = 243, 80.9% with clinically elevated depression and/or anxiety) reported positive and negative affect during meditation practice. Data were analyzed using two-level multivariate latent growth curve models (observations nested within participants) that simultaneously attended to both positive and negative affect. We examined whether positive and negative affect during meditation changed over time and whether these changes were associated with changes in psychological distress (parent trial's preregistered primary outcome) at posttest or 3-month follow-up. RESULTS: On average, participants reported decreased negative affect but no change in positive affect during meditation over time. Increased positive affect and decreased negative affect during meditation were associated with improvements in distress at posttest and follow-up. Change in positive affect was a stronger predictor of distress at follow-up than change in negative affect. CONCLUSIONS: Despite notions embedded within mainstream mindfulness meditation training that deemphasize the importance of the affective experience of practice (i.e., nonjudgmental awareness of present moment experience, regardless of valence), results indicate that these experiences contain signals associated with outcomes. Monitoring affect during meditation may be worthwhile to guide intervention delivery (i.e., measurement-based care, precision medicine). (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Outcome prediction in psychological therapy with continuous time dynamic modeling of affective states and emotion regulation.
Hehlmann MI, Moggia D, Schwartz B … +3 more , Driver C, Eberhardt S, Lutz W
J Consult Clin Psychol · 2024 Aug · PMID 39347787 · Publisher ↗
OBJECTIVE: To date, many prediction studies in psychotherapy research have used cross-sectional data to predict treatment outcome. The present study used intensive longitudinal assessments and continuous time dynamic mod...
OBJECTIVE: To date, many prediction studies in psychotherapy research have used cross-sectional data to predict treatment outcome. The present study used intensive longitudinal assessments and continuous time dynamic modeling (CTDM) to investigate the temporal dynamics of affective states and emotion regulation in the early phase of therapy and their ability to predict treatment outcome. METHOD: Ninety-one patients undergoing psychological treatment at a university outpatient clinic took part in a 2-week ecological momentary assessment (EMA) period. Participants answered self-report measures on positive affect (PA), negative affect, and emotion regulation (ER) four times a day. Hierarchical Bayesian CTDM was conducted to identify temporal effects within (autoregressive) and between (cross-regressive) PA, negative affect, and ER. The resulting CTDM parameters, simple EMA parameters (e.g., mean), and cross-sectional predictors were entered into a LASSO model to be examined as predictors of treatment outcome at Session 15. RESULTS: Two significant predictors were identified: initial impairment and the continuous time cross-effect of PA on ER. The final model explained 40% of variance in treatment outcome, with the cross-effect (PA-ER) accounting for 4% of variance beyond initial impairment. CONCLUSIONS: The results demonstrate that temporal patterns of affective EMA data are valuable for the mapping of individual differences and the prediction of treatment outcome. This information can be used to provide therapists with feedback to personalize treatments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Negative affect variability as a potential mechanism of behavior change in alcohol use disorder treatment.
Linn BK, Zhao J, Stasiewicz PR … +4 more , Wilding GE, LaBarre C, Knapp KS, Bradizza CM
J Consult Clin Psychol · 2024 Aug · PMID 39347786 · Publisher ↗
OBJECTIVE: Negative affect and affect variability figure prominently in models of addictive behaviors but are not without controversy. Negative affect variability may better capture a mechanism of behavior change in alco...
OBJECTIVE: Negative affect and affect variability figure prominently in models of addictive behaviors but are not without controversy. Negative affect variability may better capture a mechanism of behavior change in alcohol use disorder (AUD) treatment because it contains information about affect regulation, a common clinical target. The aims of this study are to examine the change in: (a) trajectory of negative affect variability, (b) association of negative affect variability and abstinence, and (c) association of negative affect variability and heavy drinking during AUD treatment. METHOD: This article is a secondary analysis of data drawn from a randomized clinical trial. = 181 participants diagnosed with AUD ( = 50.8, = 10.6; 51.4% female) received 12 sessions of Cognitive Behavioral Coping Skills Therapy for AUD. Participants completed one daily diary prompt per day for 84 consecutive days. Each day, participants reported on negative affect and number of alcoholic drinks consumed the previous day. Time-varying effect models examined changes in negative affect variability and its associations with abstinence and heavy drinking. RESULTS: Negative affect variability decreased throughout treatment. The positive association between negative affect variability and heavy drinking became nonsignificant (decoupled) midway through treatment. The inverse association between negative affect variability and daily abstinence became nonsignificant (decoupled) at approximately day 75 of 84. When mean levels of NA were added as a covariate, the effects were in the same direction but no longer statistically significant. CONCLUSION: Reductions in negative affect variability may capture an important change mechanism of behavioral treatments for AUD because it contains information about affect regulation as compared with mean levels of negative affect. Negative affect variability warrants further consideration as a mechanism of behavior change. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Evidence for a vicious socioemotional cycle of negative emotions and interpersonal conflict.
Vize CE, Ringwald WR, Scott LN … +3 more , Kamarck TW, Pilkonis PA, Wright AGC
J Consult Clin Psychol · 2024 Aug · PMID 39347785 · Full text
UNLABELLED: Interpersonal and emotional functioning are closely linked and reciprocally influence one another. Contemporary integrative interpersonal theory (CIIT) offers a useful framework to conceptualize these patter...
UNLABELLED: Interpersonal and emotional functioning are closely linked and reciprocally influence one another. Contemporary integrative interpersonal theory (CIIT) offers a useful framework to conceptualize these patterns and guide interventions in cases where these patterns result in dysfunction. Stress processes offer several dynamic frameworks to guide empirical investigations using methods that allow for fine-grained analyses in the context of daily life. METHOD: Four samples of adults (Sample 1, = 145; Sample 2, = 160; Sample 3, = 297; Sample 4 = 89 dyads, 178 individuals) completed ecological momentary assessment protocols focused on a variety of interpersonal and emotional experiences. Samples were enriched for aggressive and self-harming behavior (Sample 1), trait hostility (Sample 2), interpersonal problems (Sample 3), and personality disorder features (Sample 4). RESULTS: Using multilevel dynamic structural equation modeling, we investigated how emotions and interpersonal functioning operate over brief timescales in daily life. We found evidence for a vicious socioemotional cycle across all four samples, whereby negative emotions related to interpersonal conflict (i.e., perceptions of and enacting cold, antagonistic, or quarrelsome behavior; components that contribute to the interpersonal situation from the perspective of CIIT) which in turn related to increased negative emotions. Although individuals differed in the strength of this process, it was unrelated to trait negative affectivity. CONCLUSIONS: Viewing these results through the lens of CIIT, we discuss multiple intervention points highlighted by these dynamic results whereby the vicious cycle might be changed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
The role of affect dynamics as mechanisms of change in mental health interventions: Integrating applied and basic science.
Bar-Kalifa E, Bringmann LF, Zilcha-Mano S
J Consult Clin Psychol · 2024 Aug · PMID 39347784 · Publisher ↗
In recent years, there has been growing empirical interest in examining the role of affect dynamics in mental health. However, research on affect has largely progressed independently in the basic and applied sciences, yi...
In recent years, there has been growing empirical interest in examining the role of affect dynamics in mental health. However, research on affect has largely progressed independently in the basic and applied sciences, yielding significant advances in each domain but little cross-disciplinary integration. This special issue addresses this gap by showcasing some of the most promising recent developments in the field. The articles featured in this special issue offer insights into key innovations in affect dynamics and their potential implications for mental health interventions. Comprising a total of 17 articles, the issue is divided into two sections: Daily Life Assessment of Affect, encompassing seven articles, and In-Treatment Assessment of Affect, comprising 10 articles. In this editorial, we synthesize the contributions of these articles and propose a set of fundamental principles for conducting and interpreting research on the role of affect dynamics as mechanisms of change in mental health interventions. These principles encompass (a) the content of affect research related to mental health and its treatment (the What), (b) the timing of the assessment (the When), (c) the target populations under investigation (the Who), and (d) the methodologies employed (the How). The synthesis presented here, along with the articles featured in this special issue, holds significant potential to inform clinical research and practice on the role of affect dynamics in mental health interventions and stimulate future scientific inquiry in this important area. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
A randomized controlled trial comparing brief online self-guided interventions for loneliness.
Kaveladze BT, Gastelum SF, Ngo DC … +6 more , Delacruz P, Cohen KA, Käll A, Andersson G, Schleider JL, Schueller SM
J Consult Clin Psychol · 2025 Jan · PMID 39325409 · Full text
OBJECTIVE: Loneliness is a global health issue, but current loneliness interventions are not scalable enough to reach many who might benefit from them. Brief online interventions could greatly expand access to evidence-b...
OBJECTIVE: Loneliness is a global health issue, but current loneliness interventions are not scalable enough to reach many who might benefit from them. Brief online interventions could greatly expand access to evidence-based loneliness interventions. METHOD: We conducted a preregistered three-armed trial ( = 908, ages 16-78) to compare three self-guided online interventions: a single-session intervention (SSI) for loneliness, a 3-week, three-session intervention for loneliness, and an active control supportive therapy SSI (https://ClinicalTrials.gov, ID: NCT05687162). RESULTS: Loneliness decreased between baseline and Week 8 across all conditions ( = -5.80; = -0.55; 95% CI [-0.62, -0.47]; < .01), but did not decrease significantly more in those assigned to either the loneliness SSI (b = -1.27; = -0.12; 95% CI [-0.30, 0.06]; = .20) or the 3-week intervention ( = -0.93; = -0.09; 95% CI [-0.27, 0.09]; = .34) than those assigned to the control SSI. Participants found all three interventions acceptable but rated both loneliness interventions as more acceptable than the control ( < .01). Far more participants completed the 10-min control SSI (86.6%) and 20-min loneliness SSI (69.4%) than the 60-min 3-week intervention (14.9%). CONCLUSIONS: An SSI for loneliness was not significantly less effective than a longer loneliness intervention and had a much higher completion rate. Yet, against our hypotheses, neither loneliness intervention reduced loneliness more than an active control SSI did. Future work should aim to design more effective SSIs for loneliness and identify populations for which SSIs might be most helpful. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
The relationship between attachment needs, earned secure therapeutic attachment and outcome in adult psychotherapy.
Jacobsen CF, Falkenström F, Castonguay L … +4 more , Nielsen J, Lunn S, Lauritzen L, Poulsen S
J Consult Clin Psychol · 2024 Jul · PMID 39190445 · Publisher ↗
OBJECTIVE: The aim of this study was to investigate a sequence of associations between clients' pretreatment attachment style, the development of individuated-secure attachment to the therapist (i.e., therapeutic attachm...
OBJECTIVE: The aim of this study was to investigate a sequence of associations between clients' pretreatment attachment style, the development of individuated-secure attachment to the therapist (i.e., therapeutic attachment), and the experience of increased comfort with emotional closeness (growing engagement) or independence (growing autonomy) in therapy. Moreover, the study explored whether clients' experience of growing engagement or growing autonomy was associated with a change in interpersonal problems at the end of therapy. METHOD: Three hundred thirty adult clients (mean age 40.2, 75% female) were seen by 44 therapists in individual psychotherapy. The associations between pretreatment attachment insecurity measured on the Experiences in Close Relationships scale, repeated measures of therapeutic attachment measured on the Client Attachment to Therapist Scale, repeated measures of a growing engagement or growing autonomy measured on the Therapeutic Distance Scale, and pre-post measures of interpersonal problems measured on the Inventory for Interpersonal Problems were analyzed using multilevel modeling. Two types of therapeutic attachment were estimated, one controlling for anxious attachment characteristics and one for avoidant. RESULTS: Significant associations between higher levels of therapeutic attachment controlled for avoidant attachment characteristics and lower levels of growing autonomy in therapy were found. Moreover, higher levels of growing engagement in therapy and higher levels of therapeutic attachment controlled for anxious attachment characteristics were associated with a decrease in interpersonal problems at the end of therapy. CONCLUSIONS: Distinct types of therapeutic attachment may exert different influences on the process and outcome of therapy. Furthermore, therapists' attunement to clients' specific attachment needs in therapy may enhance interpersonal outcomes of treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Working alliance in exposure-based treatments of posttraumatic stress disorder related to childhood abuse.
Oprel DAC, Hoeboer CM, Schoorl M … +3 more , de Kleine RA, van der Does W, van Minnen A
J Consult Clin Psychol · 2024 Jul · PMID 39190444 · Publisher ↗
OBJECTIVES: Working alliance is considered an important determinant of outcome of psychotherapy. Patients with posttraumatic stress disorder (PTSD) following childhood abuse (CA-PTSD) may have challenges in building inte...
OBJECTIVES: Working alliance is considered an important determinant of outcome of psychotherapy. Patients with posttraumatic stress disorder (PTSD) following childhood abuse (CA-PTSD) may have challenges in building interpersonal relationships, including working alliance. Phase-based treatment provides an opportunity to strengthen alliance prior to trauma-focused treatment. This study aimed to compare the development of working alliance among patients with CA-PTSD in three variants of prolonged exposure (PE) therapy: standard PE, intensive PE (iPE), and skill training in affective and interpersonal regulation + prolonged exposure (STAIR + PE). We also examined the effect of alliance on treatment outcome and dropout. METHOD: Self-reported PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (Blevins et al., 2015) and patient-rated Working Alliance Inventory (Tracey & Kokotovic, 1989) were assessed in a clinical trial. We analyzed data from 138 adult patients (76.1% female; 42% non-Western). Analyses were performed using mixed-effects models. RESULTS: Patients established a satisfactory alliance early in treatment, which increased over time. For PE and STAIR + PE, a larger decrease in PTSD symptom severity was related to a higher alliance in the subsequent session, but not the other way around. In STAIR + PE, a higher alliance in Phase 1 was related to lower PTSD symptoms in Phase 2. In all conditions, a higher initial working alliance was related to a lower chance of treatment dropout. CONCLUSION: In the treatment of CA-PTSD, all three variants of prolonged exposure foster positive development of the working alliance. Across conditions, working alliance did not precede symptom decline. Therapists should strive for a strong alliance at the beginning of treatment as this reduces the likelihood of dropout. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Do improvements in motivational language predict alcohol use in motivational interviewing? Ambivalence matters.
Forman DP, Houck JM, Moyers TB
J Consult Clin Psychol · 2024 Jul · PMID 39190443 · Full text
OBJECTIVE: Motivational Interviewing (MI) is described as a method for improving clinical outcomes by reducing client ambivalence. If this is true, MI's focus on improving clients' motivational language should be most us...
OBJECTIVE: Motivational Interviewing (MI) is described as a method for improving clinical outcomes by reducing client ambivalence. If this is true, MI's focus on improving clients' motivational language should be most useful for clients with ambivalence about change and less valuable for those who are ready to implement new behaviors or are opposed to change. To address this hypothesis and potentially add precision to MI delivery in clinical settings, we tested whether the relationship between clients' in-session motivational language and posttreatment alcohol use depended on their baseline motivation to change. METHOD: Client speech from 149 sessions from Project MATCH were analyzed. A cluster analysis of the percent change talk during the first decile of the session identified three motivational groups: opposed, ambivalent, and ready. The change in percent change talk (C-PCT) across the session was calculated for each group. Zero-inflated negative binomial analysis was used to test whether the effect of C-PCT on end-of-treatment drinking varied between motivational groups. RESULTS: The count part of the model revealed a significant interaction between C-PCT and membership in the ambivalent group (b = -17.710, 95% CI [-25.775, -9.645], p < .001), only for those who received MI. Favorable C-PCT was associated with less drinking (b = -15.735, p = .004). Only baseline drinking was a significant predictor of abstinence at follow-up (b = .032, 95% CI [0.012, 0.051], p = .001). CONCLUSION: A putative MI mechanism-improved client motivational language-appears most important for clients who express ambivalence in the opening minutes of the session, with minimal value for those who do not. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Understanding the patients' concept of the alliance-One step back to take two steps forward.
Flückiger C
J Consult Clin Psychol · 2024 Jul · PMID 39190442 · Publisher ↗
Current health care systems emphasize consensual collaboration between clinicians and patients to reduce symptoms and improve well-being (e.g., World Health Organization, 2023). The alliance is the internationally best-s...
Current health care systems emphasize consensual collaboration between clinicians and patients to reduce symptoms and improve well-being (e.g., World Health Organization, 2023). The alliance is the internationally best-studied collaborative process characteristic in psychotherapy research. Recent empirical studies on the alliance have tripled in comparison to the entire 20th century. This increase in empirical data illustrates the cumulative outstanding scientific activities in this field (e.g., Wampold & Flückiger, 2023). The reasons for the international popularity of the pantheoretical alliance concept may lie in the practical experience of many practitioners that a balanced collaborative quality is a central ethical and conceptual premise for treatment progress (Horvath, 2018). The aim of a "Viewpoint" article is to provide thought-provoking notes on the current state of research, innovations, weaknesses in the field, and current debates. This article is limited to three aspects. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Multimodal analysis of temporal affective variability within treatment for depression.
Paz A, Rafaeli E, Bar-Kalifa E … +4 more , Gilboa-Schechtman E, Gannot S, Narayanan SS, Atzil-Slonim D
J Consult Clin Psychol · 2024 Sep · PMID 39052383 · Publisher ↗
OBJECTIVE: Affective flexibility, the capacity to respond to life's varying environmental changes in a dynamic and adaptive manner, is considered a central aspect of psychological health in many psychotherapeutic approac...
OBJECTIVE: Affective flexibility, the capacity to respond to life's varying environmental changes in a dynamic and adaptive manner, is considered a central aspect of psychological health in many psychotherapeutic approaches. The present study examined whether affective two-dimensional (i.e., arousal and valence) temporal variability extracted from voice and facial expressions would be associated with positive changes over the course of psychotherapy, at the session, client, and treatment levels. METHOD: A total of 22,741 mean vocal arousal and facial expression valence observations were extracted from 137 therapy sessions in a sample of 30 clients treated for major depressive disorder by nine therapists. Before and after each session, the clients self-reported their level of well-being on the outcome rating scale. Session-level affective temporal variability was assessed as the mean square of successive differences between consecutive two-dimensional affective measures. RESULTS: Session outcome was positively associated with temporal variability at the session level (i.e., within clients, between sessions) and at the client level (i.e., between clients). Importantly, these associations held when controlling for average session- and client-level valence scores. In addition, the expansion of temporal variability throughout treatment was associated with steeper positive session outcome trajectories over the course of treatment. CONCLUSIONS: The continuous assessment of both vocal and facial affective expressions and the ability to extract measures of affective temporal variability from within-session data may enable therapists to better respond and modulate clients' affective flexibility; however, further research is necessary to determine whether there is a causal link between affective temporal variability and psychotherapy outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Reducing intrusive suicidal mental images in patients with depressive symptoms through a dual-task add-on module: Results of a multicenter randomized clinical trial.
van Bentum JS, Sijbrandij M, Kerkhof AJFM … +17 more , Holmes EA, Arntz A, Bachrach N, Bollen CSC, Creemers D, van Dijk MK, Dingemanse P, van Haaren M, Hesseling M, Huisman A, Kraanen FL, Stikkelbroek Y, Twisk J, Van HL, Vrijsen J, de Winter RFP, Huibers MJH
J Consult Clin Psychol · 2024 Nov · PMID 39023986 · Publisher ↗
OBJECTIVE: To examine the safety and efficacy of a brief cognitive dual-task (using eye movements) add-on module to treatment as usual (TAU) in reducing the severity and frequency of intrusive suicidal mental images and...
OBJECTIVE: To examine the safety and efficacy of a brief cognitive dual-task (using eye movements) add-on module to treatment as usual (TAU) in reducing the severity and frequency of intrusive suicidal mental images and suicidal ideation. METHOD: We conducted a single-blind, parallel multicenter randomized trial (No. NTR7563) among adult psychiatric outpatients ( = 91; = 34.4, = 13.54; 68% female) with elevated depressive symptoms and experiencing distressing suicidal intrusions in the Netherlands. Primary outcome was the severity (Suicidal Intrusions Attributes Scale) and frequency (Clinical Interview for Suicidal Intrusions) of suicidal mental imagery intrusions at 1-week posttreatment and 3-month follow-up. Primary analysis was intention-to-treat. RESULTS: Between November 27, 2018 and September 13, 2021, 91 patients were included and randomly assigned to intervention group (Cognitive Dual Task Add-on + TAU) ( = 46) or TAU-only ( = 45). Cognitive Dual Task Add-on + TAU had greater reductions in severity (mean difference, -15.50, 95% CI [23.81, -7.19]; < .001, d = 0.60), and frequency (geometric mean difference, 0.47, 95% CI [0.29, 0.79]; = .004) of suicidal intrusions over time than TAU-alone. Cognitive Dual Task Add-on + TAU patients also showed lower suicidal ideation over time ( = .008, = 0.42). There were no significant group differences in reductions in depressive symptoms, rumination, or hopelessness. Four serious adverse events occurred (three Cognitive Dual Task Add-on + TAU; one TAU-only); all unlikely attributable to intervention/trial. CONCLUSIONS: Findings provide support for the effectiveness of adding a cognitive dual-task module to the treatment of psychiatric outpatients with elevated depressive symptoms in reducing suicidal intrusions and ideation and can be executed safely. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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