Preventing dropout in spiritually integrated psychotherapies: What are the effective methods of attending to clients' spirituality?

The purpose of this study was to examine associations between clinicians' use of varying types of spiritual interventions in the first session of spiritually integrated psychotherapies (SIPs) and clients' likelihood of returning for a second session. In total, 154 practitioners of SIPs from 33 settings in a practice-research network reported on their implementation of different methods for addressing clients' religion/spirituality on an after-session summary checklist. Roughly 80% or more of the clinicians implemented at least one spiritual intervention in the first session; on average, clinicians used 3.26 (SD = 3.66) of the interventions on the checklist. Occurring with 20% or more of the 1,094 clients, the most commonly used spiritual interventions included listening to spiritual issues, discussing compassion and hope, affirming clients' divine worth and attempts to trust God. In total, nearly one in five clients did not return for a second session. Focusing on interventions that were empirically linked with clients' engagement in a second session in bivariate analyses, discussion of spiritual dimensions of clients' problems and solutions was associated with a 118% greater probability that clients engaged in SIPs; in contrast, discussion of hope was linked with a 40% decrease in treatment engagement. In conclusion, findings highlight the potential opportunities and risks for implementing interventions that attend to clients' spirituality and/or religious faith at the start of SIPs. Research is needed to understand factors associated with the effective use of spiritual interventions and methods of training clinicians accordingly. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

No client left behind: A meta-analysis of premature termination from psychotherapy in U.S. service members and veterans.

Dropout has been identified as a significant problem among military populations seeking psychotherapy (Goetter et al., 2015; Hoge et al., 2014), yet an overall estimate of its exact prevalence and predictors does not exist. The aims of the current meta-analysis were to estimate outpatient psychotherapy dropout rates for this population and evaluate potential moderators of this event. In total, 283 articles-comprising data from 719,465 U.S. service members and veterans-met all inclusion criteria and were included in the meta-analysis. The average weighted dropout rate for all outpatient therapies was 25.6%, 95% CI [22.4%, 29.2%], and prediction interval [1.9%, 85.9%]. Furthermore, dropout was 27.0% for cognitive behavioral therapies (CBTs), 25.3% for trauma treatments, 27.6% for the Department of Veterans Affairs (VA), 28.9% for individual therapies, and 9.8% for intensive outpatient settings. Findings from metaregression analyses using mixed-effects models indicated that higher dropout was linked with the following after accounting for other moderators: younger age, CBTs, nonmanualized approaches, VA versus Department of Defense settings, individual versus group therapies, and weekly versus intensive outpatient formats. Dropout was not linked with other client, therapist, treatment, and research variables. Taken together, dropout estimates were obtained for a range of military populations and treatment characteristics, including theoretical orientation, presenting concern, setting, and therapy formats. These estimates may provide potential benchmarks for therapists, administrators, and policymakers serving military populations. Leveraging dropout prevention strategies with at-risk groups highlighted in this study may enhance mental health care outcomes for this high-need population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adherence to Online Interventions for Family Caregivers of People With Dementia: A Meta-Analysis and Systematic Review.

OBJECTIVE: Online interventions hold promise in supporting the well-being of family caregivers and enhancing the quality of care they provide for individuals with long-term or chronic conditions. However, dropout rates from support programs among specific groups of caregivers, such as caregivers of people with dementia, pose a challenge. Focused reviews are needed to provide more accurate insights and estimates in this specific research area. METHODS: A meta-analysis of dropout rates from available online interventions for family caregivers of people with dementia was conducted to assess treatment acceptability. A systematic search yielded 18 studies involving 1,215 caregivers. RESULTS: The overall pooled dropout rate was 18.4%, with notable heterogeneity indicating varied intervention adherence. Interventions incorporating human contact, interactive features, and personalization strategies for specific types and stages of dementia predicted significantly lower dropout rates. Methodological assessment revealed variability in study quality. CONCLUSION: Findings support the effectiveness of social support, personalization strategies, and co-design in enhancing intervention adherence among dementia family caregivers. Further research is needed to explore factors influencing dropout rates and conduct robust trials to refine the implementation of future interventions.

5-Hydroxymethylfurfural reduces skeletal muscle superoxide production and modifies force production in rats exposed to hypobaric hypoxia.

Decreased blood-tissue oxygenation at high altitude (HA) increases mitochondrial oxidant production and reduces exercise capacity. 5-Hydroxymethylfurfural (5-HMF) is an antioxidant that increases hemoglobin's binding affinity for oxygen. For these reasons, we hypothesized that 5-HMF would improve muscle performance in rats exposed to a simulated HA of ~5500 m. A secondary objective was to measure mitochondrial activity and dynamic regulation of fission and fusion because they are linked processes impacted by HA. Fisher 344 rats received 5-HMF (40 mg/kg/day) or vehicle during exposure to sea level or HA for 72 h. Right ankle plantarflexor muscle function was measured pre- and post-exposure. Post-exposure measurements included arterial blood gas and complete blood count, flexor digitorum brevis myofiber superoxide production and mitochondrial membrane potential (ΔΨm), and mitochondrial dynamic regulation in the soleus muscle. HA reduced blood oxygenation, increased superoxide levels and lowered ΔΨm, responses that were accompanied by decreased peak isometric torque and force production at frequencies >75 Hz. 5-HMF increased isometric force production and lowered oxidant production at sea level. In HA exposed animals, 5-HMF prevented a decline in isometric force production at 75-125 Hz, prevented an increase in superoxide levels, further decreased ΔΨm, and increased mitochondrial fusion 2 protein expression. These results suggest that 5-HMF may prevent a decrease in hypoxic force production during submaximal isometric contractions by an antioxidant mechanism.

Effort and effort discounting as predictors of seeking psychotherapy among individuals with depression.

OBJECTIVES: Many individuals who experience depression do not seek psychotherapy, and past research has had limited success in predicting help-seeking in this population. Accounting for behavioral characteristics of depression that affect help-seeking decisions, such as effort discounting (devaluation of rewards as a function of effort), may address this gap. METHODS: Individuals with moderate-severe depression symptoms who were not in psychotherapy (N = 253) reported their depression symptom severity and the amount of effort they anticipated seeking psychotherapy would require; they also completed a behavioral measure of effort discounting. At a 3-month follow-up, they reported whether they initiated psychotherapy during the follow-up period. RESULTS: Depression symptom severity was associated with perceptions that seeking psychotherapy would be more effortful. In turn, perceptions that seeking psychotherapy would be more effortful prospectively predicted a lower likelihood of initiating psychotherapy. Effort discounting was unrelated to psychotherapy use. CONCLUSIONS: These results suggest that differences in the anticipated effort required to seek psychotherapy can increase depressed individuals' risk of going untreated. Future research may test whether reducing the effort of seeking psychotherapy increases psychotherapy use among those with depression. For instance, streamlining insurance enrollment procedures, implementing patient decision aids, or offering telehealth treatment options may be beneficial.

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

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

Patient perspectives on working with preferences in psychotherapy: A consensual qualitative research study.

OBJECTIVE: Assessing and accommodating patient preferences is integral to evidence-based practice. This qualitative study sought to explore patient perspectives and experiences of preference work in psychotherapy. METHODS: Participants were 13 UK-based patients who had completed up to 24 sessions of a collaborative-integrative psychotherapy. Ten participants identified as female and three as male. Interviews were conducted at endpoint and analyzed using a team-based, consensual qualitative research approach. RESULTS: Three superordinate domains were developed: Preferences Themselves, Process of Working with Preferences in Psychotherapy, and Effect of Preference Work (or its Absence). Patients typically wanted leadership, challenge, and input from their psychotherapist, and an affirming style. Patients attributed the origin of their preferences to personal history, characteristics, or circumstances; the present psychotherapy; or past episodes of psychotherapy. Some preferences changed over time. Preference work was described as having positive effects on the therapeutic relationship and patients' intrapersonal worlds; however, variantly, non-accommodation of preferences was also experienced as beneficial. CONCLUSION: Our findings provide in-depth answers to a range of novel questions on preference work-potential mechanisms by which preference work impacts outcomes, factors that may facilitate preference work, and origins of preferences-as well as nuancing previously-established quantitative findings. Implications for clinical training and practice are discussed.

Stigma and Intentions to Seek Psychotherapy Among Primary Care Providers During the COVID-19 Pandemic: A Mediational Analysis.

BACKGROUND: Medical personnel have reported increases in psychological distress and depression during the COVID-19 pandemic. Additionally, many providers, including primary care providers (PCPs), face significant stigma related to personal mental healthcare. However, the process by which stigma affects help-seeking among PCPs is unclear. METHOD: Between January and May 2020, 112 PCPs completed a survey of perceived public stigma, self-stigma, attitudes, intentions to seek psychotherapy for depression, and a clinical vignette on patient referrals to psychotherapy. RESULTS: Self-stigma and attitudes toward psychotherapy sequentially mediated the relationship between perceived public stigma and intentions to seek psychotherapy. PCPs were more likely to refer a depressed patient to psychotherapy than seek personal psychotherapy, but lower personal help-seeking intentions were associated with lower referral intentions. CONCLUSION: These results clarify processes by which stigma hinders PCPs' psychotherapy use and highlight interventions to encourage their help-seeking. Addressing cultural and practical barriers in the medical field is needed to reduce stigma.

Client preference accommodation for religious/spiritual integration and psychotherapy outcomes in naturalistic practice settings.

The purpose of this practice-research network study was to examine client preferences for religious/spiritual (R/S) integration and test whether preference accommodation in this area is linked to positive treatment outcomes (i.e., less dropout and greater client change). Thirteen independent practice psychotherapists and their 175 clients completed measures of R/S integration preferences and use of R/S techniques and approaches throughout treatment. Psychotherapists also completed an assessment of treatment dropout and change for each participating client. Overall, participating clients expressed moderate preferences for R/S integration, time spent on R/S topics, and an R/S match with their psychotherapists. Preferences in each of these 3 areas were stronger for R/S identifying clients (compared with non-R/S clients) and when clients believed that R/S integration was more essential to produce positive treatment outcomes. Both client R/S identification and client R/S integration preferences predicted psychotherapist's use of R/S techniques in treatment sessions. Importantly, clients' ratings of R/S preference accommodation significantly predicted psychotherapists' ratings of client treatment completion and client change. Specifically, with each unit increase on a 5-point measure of client perceptions of R/S preference accommodation, clients were 1.63 times more likely to be rated as treatment completers and 1.83 times more likely to be identified as having improved while in treatment. Implications for R/S integration in psychotherapy and future research directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Nonstigmatizing and Precise Terminology to Describe Processes and Outcomes in Addiction Medicine.

ABSTRACT: Scholarly journals and professional organizations in addiction medicine have recently discussed the importance of adopting nonstigmatizing and precise terminology. The present commentary expands that ongoing discussion to terms related to treatment processes and outcomes. Four implicit assumptions of stigmatizing and imprecise terms related to treatment processes and outcomes are overviewed, and research evidence against these assumptions is presented. The commentary ends with recommendations for the use of positive behavioral indicators of processes and outcomes and, more importantly, accompanying them with nonevaluative, objective descriptors of patients' behaviors.

Religious microaggressions in psychotherapy: A mixed methods examination of client perspectives.

Ethical guidelines state that psychologists should consider clients' religion in their practice. However, some clients have reported negative experiences regarding clinicians' treatment of religion in psychotherapy. These experiences may constitute microaggressions, which have been negatively associated with the working alliance and treatment outcomes among clients with various identities (e.g., those of marginalized racial groups or sexual orientations). The present study used mixed methods to examine religious microaggressions among current and former psychotherapy clients identifying as religious (N = 396). Approximately 39% of participants indicated that at least one religious microaggression occurred during treatment; the most common was minimization or avoidance of religious issues. Religious microaggressions were negatively associated with the working alliance and outcomes. Additionally, the working alliance fully mediated the association between religious microaggressions and poorer outcomes. Thematic analysis of qualitative descriptions of religious microaggressions yielded seven themes: minimization/avoidance of religious issues, assumptions of religious homogeneity, pathologizing religion, unhelpful/inappropriate interventions, pressure to embrace religion, prioritization of therapist's religious beliefs, and lack of expertise. Limitations include a retrospective, cross-sectional design and a majority White, female, and Christian sample. These results provide initial evidence that a substantial minority of religious clients may experience religious microaggressions in psychotherapy, which could impede treatment progress via negative effects on the working alliance. As such, clinicians may be able to enhance client outcomes by increasing awareness of religious microaggressions in their work and addressing microaggression-related alliance ruptures openly when they do occur. Implications for training are also discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The effectiveness of the Collaborative Assessment and Management of Suicidality (CAMS) compared to alternative treatment conditions: A meta-analysis.

INTRODUCTION: This meta-analysis aimed to test the efficacy of the Collaborative Assessment and Management of Suicidality (CAMS) intervention against other commonly used interventions for the treatment of suicide ideation and other suicide-related variables. METHOD: Database, expert, and root and branch searches identified nine empirical studies that directly compared CAMS to other active interventions. A random effects model was used to calculate the effect size differences between the interventions; additionally, moderators of the effect sizes were tested for suicidal ideation. RESULTS: In comparison to alternative interventions, CAMS resulted in significantly lower suicidal ideation (d = 0.25) and general distress (d = 0.29), significantly higher treatment acceptability (d = 0.42), and significantly higher hope/lower hopelessness (d = 0.88). No significant differences for suicide attempts, self-harm, other suicide-related correlates, or cost effectiveness were observed. The effect size differences for suicidal ideation were consistent across study types and quality, timing of outcome measurement, and the age and ethnicity of participants; however, the effect sizes favoring CAMS were significantly smaller with active duty military/veteran samples and with male participants. CONCLUSIONS: The existing research supports CAMS as a Well Supported intervention for suicidal ideation per Center of Disease Control and Prevention criteria. Limitations and future directions are discussed.

A comprehensive integrated drug similarity resource for in-silico drug repositioning and beyond.

Drug similarity studies are driven by the hypothesis that similar drugs should display similar therapeutic actions and thus can potentially treat a similar constellation of diseases. Drug-drug similarity has been derived by variety of direct and indirect sources of evidence and frequently shown high predictive power in discovering validated repositioning candidates as well as other in-silico drug development applications. Yet, existing resources either have limited coverage or rely on an individual source of evidence, overlooking the wealth and diversity of drug-related data sources. Hence, there has been an unmet need for a comprehensive resource integrating diverse drug-related information to derive multi-evidenced drug-drug similarities. We addressed this resource gap by compiling heterogenous information for an exhaustive set of small-molecule drugs (total of 10 367 in the current version) and systematically integrated multiple sources of evidence to derive a multi-modal drug-drug similarity network. The resulting database, 'DrugSimDB' currently includes 238 635 drug pairs with significant aggregated similarity, complemented with an interactive user-friendly web interface (http://vafaeelab.com/drugSimDB.html), which not only enables database ease of access, search, filtration and export, but also provides a variety of complementary information on queried drugs and interactions. The integration approach can flexibly incorporate further drug information into the similarity network, providing an easily extendable platform. The database compilation and construction source-code has been well-documented and semi-automated for any-time upgrade to account for new drugs and up-to-date drug information.

A Behavioral Economic Model of Help-Seeking for Depression.

Findings from the clinical psychology literature indicate that many who experience depression do not seek treatment when needed. This may be due to help-seeking models and interventions failing to account for the behavioral characteristics of depression that affect decision making (e.g., altered sensitivity to punishment and reward). Behavioral economics can provide a framework for studying help-seeking among individuals with depression that explicitly considers such characteristics. In particular, the authors propose that depression influences help-seeking by altering sensitivity to treatment-related gains and losses and to the delays, effort, probabilities, and social distance associated with those gains and losses. Additional biases in decision making (e.g., sunk-cost bias, default bias) are also proposed to be relevant to help-seeking decisions among individuals with depression. Strengths, limitations, and future directions for research using this theoretical framework are discussed. Taken together, a behavioral economic model of help-seeking for depression could assist in identifying those who are at greatest risk of going untreated and in creating more effective help-seeking interventions.

Client and therapist agreement in moment-to-moment helpfulness ratings in psychotherapy: A microprocess approach.

METHOD: Clients (n = 16; Mage = 32.88 years; 81% female) and their therapists (n = 10; 80% female) from a training clinic provided moment-to-moment ratings while reviewing a video recording of a recent session. West and Kenny's Truth-and-Bias (T&B) model was used to examine agreement in ratings. Multilevel modeling was used to evaluate the agreement-alliance association while controlling for sessions completed. RESULTS: Consistent with the T&B model, client-therapist ratings were temporally congruent and were not discrepant overall. Greater congruence and smaller discrepancies were linked with stronger alliances. CONCLUSIONS: The within-session and between-dyad variability in helpfulness ratings highlight the utility of moment-to-moment rating methods. Findings suggest that therapists should attune to client perceptions on a within-session level and attunement may be a target for enhancing the alliance.

Carbon Monoxide and Exercise Prevents Diet-Induced Obesity and Metabolic Dysregulation Without Affecting Bone.

OBJECTIVE: Carbon monoxide (CO) may counteract obesity and metabolic dysfunction in rodents consuming high-fat diets, but the skeletal effects are not understood. This study investigated whether low-dose inhaled CO (250 ppm) with or without moderate intensity aerobic exercise (3 h/wk) would limit diet-induced obesity and metabolic dysregulation and preserve bone health. METHODS: Obesity-resistant (OR) rats served as controls, and obesity-prone (OP) rats were randomized to sedentary, sedentary plus CO, exercise, or CO plus exercise. For 10 weeks, OP rats consumed a high-fat, high-sucrose diet, whereas OR rats consumed a low-fat control diet. Measurements included indicators of obesity and metabolism, bone turnover markers, femoral geometry and microarchitecture, bone mechanical properties, and tibial morphometry. RESULTS: A high-fat, high-sucrose diet led to obesity, hyperinsulinemia, and hyperleptinemia, without impacting bone. CO alone led only to a modest reduction in weight gain. Exercise attenuated weight gain and improved the metabolic profile; however, bone fragility increased. Combined CO and exercise led to body mass reduction and a metabolic state similar to control OR rats and prevented the exercise-induced increase in bone fragility. CONCLUSIONS: CO and aerobic exercise training prevent obesity and metabolic sequelae of nutrient excess while stabilizing bone physiology.

Shared decision-making in mental and behavioural health interventions.

Elements of shared decision-making (ie, collaboration, patient preferences, and working alliance) have long been discussed and studied in the field of clinical psychology; however, research indicates that shared decision-making is not typically used in clinical practice. Instead, clinicians often rely on a paternalistic approach. In this article, we provide a narrative review of the existing research supporting shared decision-making for mental and behavioural health concerns, we discuss several barriers that impede its use in actual clinical practice, and we provide recommendations for increasing shared decision-making when working with patients.

Cardiovascular Parameters in a Swine Model of Normobaric Hypoxia Treated With 5-Hydroxymethyl-2-Furfural (5-HMF).

INTRODUCTION: The consequences of low partial pressure of O2 include low arterial O2 saturations (SaO2), low blood O2 content (CaO2), elevated mean pulmonary artery pressure (PAP), and decreased O2 consumption VO2. 5-hydroxymethyl-2-furfural (5-HMF) binds to the N-terminal valine of hemoglobin (HgB) and increases its affinity to O2. We used an instrumented, sedated swine model to study the effect of 5-HMF on cardiovascular parameters during exposure to acute normobaric hypoxia (NH). METHODS: Twenty-three sedated and instrumented swine were randomly assigned to one of three treatment groups and received equal volume of normal saline (VEH), 20 mg/kg 5-HMF (5-HMF-20) or 40 mg/kg 5-HMF (5-HMF-40). Animals then breathed 10% FiO2 for 120 min. Parameters recorded were Cardiac Output (CO), Mean Arterial Blood Pressure (MAP), Heart Rate (HR), Mean Pulmonary Artery Pressure (PAP), SaO2 and saturation of mixed venous blood (SvO2). The P50 was measured at fixed time intervals prior to and during NH. RESULTS: 5-HMF decreased P50. In the first 30 min of NH, treatment with 5-HMF-20 and 5-HMF-40 resulted in a (1) significantly smaller decrement in SaO2 and SvO2, (2) significantly lower HR and CO, and (3) smaller increase in PAP compared to VEH. In the 120 min of NH there was a trend toward improved mortality with 5-HMF treatment. CONCLUSION: 5-HMF treatment decreased P50, improved SaO2, and mitigated increases in PAP in this swine model of NH.

Developing a collaborative relationship with clients during the initial sessions of psychotherapy.

Establishing a collaborative therapeutic relationship is an important research-supported goal for the initial sessions of psychotherapy. Fostering a collaborative relationship can occur through strategies such as recognizing the client's expertise in treatment, involving the client in the treatment decision-making process, and discussing the possibility of therapist mistakes. In this article, we present theoretical and research support for establishing a collaborative relationship. We then provide a case example that illustrates different collaboration-building strategies. The article concludes with several clinical recommendations for how therapists can increase client collaboration in the initial sessions of treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).