Measuring psychotherapist functioning with the Therapist Work Involvement Scales (TWIS): reliability, factor structure, and measurement invariance.

OBJECTIVES: The Therapist Work Involvement Scales (TWIS) is a self-report research instrument that enables a multilayered description of psychotherapists' experiences when treating clients. The TWIS was created in a comprehensive study of close to 5,000 psychotherapists, and has been used in multiple studies. The aim of the current paper is to clarify the organization and statistical characteristics of the TWIS, and to present an updated version for longitudinal and cross-sectional research. METHODS: Collection of a large sample of psychotherapy trainees made possible the use of confirmatory factor analysis (CFA) to evaluate the dimensions and structure of therapists' process experiences, assessing reliabilities, measurement invariance over gender, item statistics, and correlations with other measures to show concurrent and predictive validity. RESULTS: The CFAs largely confirmed the factor structure of four of the five facets, and of the global super-factors. The global factors of Healing Involvement and Stressful Involvement each showed substantial correlations with therapists' attachment style and professional growth, and were used to describe four practice patterns that typify the experiences of therapists. CONCLUSION: The results have shown the TWIS to be a statistically sound, multidimensional research instrument enabling therapists to describe their experience in current therapeutic work.

Scaling Properties of Liquid Dynamics Predicted from a Single Configuration: Pseudoisomorphs for Harmonic-Bonded Molecules.

Isomorphs are curves in the thermodynamic phase diagram of invariant excess entropy, structure, and dynamics, while pseudoisomorphs are curves of invariant structure and dynamics, but not of the excess entropy. The latter curves have been shown to exist in molecular models with flexible bonds [Olsen, A. E. J. Chem. Phys. 2016, 145, 241103]. We here present three force-based methods to trace out pseudoisomorphs based on a single configuration and test them on the asymmetric dumbbell and 10-bead Lennard-Jones chain models with bonds modeled as harmonic springs. The three methods are based on requiring that particle forces, center-of-mass forces, and torques, respectively, are invariant in reduced units. For each of the two investigated models we identify a method that works well for tracing out pseudoisomorphs, but these methods are not the same. Overall, we find that the more internal degrees of freedom there are in the molecule studied, the less they appear to affect the gross dynamical behavior. Moreover, the "internal" degrees of freedom (including rotation) do not significantly affect the scaling behavior of the dynamical/transport coefficients provided some 'quenching' is performed.

Cranioencephalic functional lymphoid units in glioblastoma.

The ecosystem of brain tumors is considered immunosuppressed, but our current knowledge may be incomplete. Here we analyzed clinical cell and tissue specimens derived from patients presenting with glioblastoma or nonmalignant intracranial disease to report that the cranial bone (CB) marrow, in juxtaposition to treatment-naive glioblastoma tumors, harbors active lymphoid populations at the time of initial diagnosis. Clinical and anatomical imaging, single-cell molecular and immune cell profiling and quantification of tumor reactivity identified CD8+ T cell clonotypes in the CB that were also found in the tumor. These were characterized by acute and durable antitumor response rooted in the entire T cell developmental spectrum. In contrast to distal bone marrow, the CB niche proximal to the tumor showed increased frequencies of tumor-reactive CD8+ effector types expressing the lymphoid egress marker S1PR1. In line with this, cranial enhancement of CXCR4 radiolabel may serve as a surrogate marker indicating focal association with improved progression-free survival. The data of this study advocate preservation and further exploitation of these cranioencephalic units for the clinical care of glioblastoma.

An examination of therapists' professional characteristics as moderators of the effect of feedback on psychological treatment outcomes.

Feedback-informed treatment (FIT) has been shown to reduce the gap between more and less effective therapists. This study aimed to examine therapists' professional characteristics as potential moderators of the effect of feedback on treatment outcomes.The IAPT-FIT Trial was a clinical trial where therapists were randomly assigned to a FIT group or a usual care control group. Treatment response was monitored using measures of depression (PHQ-9), anxiety (GAD-7) and functional impairment (WSAS). In a secondary analysis of this trial (n = 1,835 patients; t = 67 therapists), we used multilevel modelling to examine interactions between therapists' professional characteristics (e.g., attitude towards and self-efficacy regarding feedback utilization, decision-making style, job satisfaction, burnout, difficulties in practice, coping styles, caseload size) with random allocation (FIT vs. controls) to identify moderators of the effects of feedback.Between 9.6% and 10.8% of variability in treatment outcomes was attributable to therapist effects. Therapist-level caseload sizes and external feedback propensity (EFP) moderated the effect of feedback on depression outcomes. No statistically significant main effects were found for any of the included therapist characteristics.FIT reduced variability in outcomes between therapists and was particularly effective for therapists with high EFP and larger caseloads.

Scaling Properties of Liquid Dynamics Predicted from a Single Configuration: Small Rigid Molecules.

Isomorphs are curves in the thermodynamic phase diagram along which structure and dynamics are invariant to a good approximation. There are two main ways to trace out isomorphs, the configurational-adiabat method and the direct-isomorph-check method. Recently a new method based on the scaling properties of forces was introduced and shown to work very well for atomic systems [T. B. Schrøder, Phys. Rev. Lett. 2022, 129, 245501]. A unique feature of this method is that it only requires a single equilibrium configuration for tracing out an isomorph. We here test generalizations of this method to molecular systems and compare to simulations of three simple molecular models: the asymmetric dumbbell model of two Lennard-Jones spheres, the symmetric inverse-power-law dumbbell model, and the Lewis-Wahnström o-terphenyl model. We introduce and test two force-based and one torque-based methods, all of which require just a single configuration for tracing out an isomorph. Overall, the method based on requiring invariant center-of-mass reduced forces works best.

Predicting Scaling Properties from a Single Fluid Configuration.

Time-dependent dynamical properties of a fluid cannot be estimated directly from a single configuration without performing a simulation. Here, however, we present a method that predicts the scaling properties of both structure and dynamics from a single configuration. The method is demonstrated to work well for the Lennard-Jones fluid as well as the viscous Kob-Andersen Lennard-Jones mixture, both in and out of equilibrium. The method is conceptually simple and easy to implement and, thus, should become a standard tool in the study of scaling properties of fluids and liquids.

Changing to remote psychological therapy during COVID-19: Psychological therapists' experience of the working alliance, therapeutic boundaries and work involvement.

RESEARCH AIMS: This study aimed to investigate psychological therapists' perceived ability to form a working alliance and maintain therapeutic boundaries, and their work involvement patterns whilst working remotely via telephone or videoconferencing. Furthermore, the study aimed to explore therapists' experience of therapeutic boundaries when working remotely and how they managed these. METHOD: A mixed-method sequential explanatory design was adopted. Descriptive and inferential statistics were used to analyse quantitative data, with thematic analysis used to analyse qualitative data. RESULTS: In total, 161 psychological therapists completed an online survey, and 12 participants were selected using maximum variation sampling to engage in a semi-structured interview. Although results between therapists varied, some perceived abilities regarding the working alliance and therapeutic boundaries differed when working remotely compared to face-to-face therapy. Therapists' work involvement patterns also differed compared to existing data for face-to-face therapy, indicated by increased rates of stressful involvement. Considering therapists' experience of therapeutic boundaries, four overarching themes were identified: 'different boundaries in remote therapy', 'work home boundary', 'changes in the therapeutic safe space' and 'impact of boundaries when working remotely'. CONCLUSIONS: Aspects of the working alliance and therapeutic boundaries are experienced differently by therapists working remotely, which relates to how they experience their work. The findings have clinical implications for increasing therapists' awareness of potential changes in their perceived abilities regarding the working alliance and therapeutic boundaries when working remotely, therefore, enabling them to address these changes where required. Future research possibilities are considered.

Therapist-led interventions for the treatment of traumatic stress symptoms in cancer survivors: A systematic literature review.

OBJECTIVE: We reviewed the evidence regarding the effectiveness of therapist-led interventions for reducing symptoms of traumatic stress in cancer survivors. METHODS: This systematic review was completed in accordance with the guidelines illustrated by Popay and colleagues and the following online databases, PsychInfo, Medline, CINAHL, were searched for peer-reviewed literature. Further studies were searched through Google Scholar and manually scanning the reference lists of all included studies. The PRISMA guidelines were followed to report results. RESULTS: Sixteen studies were identified, their quality varied and the interventions broadly fell into two categories: CBT-based and non-CBT interventions. Effect sizes were small to moderate in 12 studies and large in four. Drop-out rates were mostly low. CONCLUSION: This review has demonstrated that the research in this field is still scarce and due to the data mostly suggesting a small to moderate effect, firm conclusions cannot be drawn on the effectiveness of the included interventions.

Psychotherapist Trainees' Quality of Life: Patterns and Correlates.

While psychotherapists are trained to improve their clients' quality of life, little work has examined the quality of life experienced by psychotherapist trainees themselves. Yet their life satisfactions and stresses would plausibly affect both their ability to learn new skills and conduct psychotherapy. Therefore, in the Society for Psychotherapy Research Interest Section on Psychotherapist Development and Training study, we investigated the patterns of self-reported life quality and their correlates in a multinational sample of 1,214 psychotherapist trainees. A comprehensive questionnaire was used at the outset of trainings to assess trainees' professional background, current life situation, personal characteristics, family background, and social and national origin. The findings indicated 54.3% of trainees' lives could be characterized as fortunate or happy (i.e., experiencing great life satisfaction and not much stress), whereas 14.3% could be characterized as clearly distressed or troubled (i.e., experiencing great life stress and not much satisfaction). The strongest correlates of high life stress, a contributor to poor life quality, were economic insecurity, self-protectiveness, and attachment-related anxiety in relationships, and economic or psychological hardship in childhood. In turn, greater wellbeing was most strongly associated with a warm and open interpersonal style, being married, having sufficient economic means, and material and emotional security in childhood. While the results indicate the majority of therapists experience a relatively good quality of life, the findings also suggest potential targets for increasing trainees' life quality when it may be deficient, such as those on a societal level (e.g., availability of low-cost student loans), training program level (e.g., promoting supportive supervision, positive between-trainee relationships and group collaboration), and individual level (e.g., personal therapy and learning self-care), in order to promote effective learning and therapy practice.

The predictive value of patient, therapist, and in-session ratings of motivational factors early in remote cognitive behavioural therapy for severe health anxiety.

OBJECTIVES: Remote psychotherapy and the prevalence of Severe Health Anxiety (SHA) are both growing as a result of the COVID-19 pandemic. Remotely delivered Cognitive Behavioural Therapy (rCBT) for SHA is evidenced as effective, but many who seek help do not benefit. Motivational processes can influence outcomes, but it is unclear what assessment methods offer the best clinical utility in rCBT for SHA. DESIGN: This study compared the predictive validity of patient, therapist and in-session ratings of motivational factors taken at session two of rCBT for SHA among high healthcare users experiencing multimorbidity. METHODS: Motivational factors were assessed for 56 participants who attended at least two sessions of CBT for SHA delivered via video-conferencing or telephone. Following session two, therapists and patients completed online assessments of patient motivation. Two trained observers also rated motivational factors and therapeutic alliance from in-session interactions using session two recordings and transcripts. Multilevel modelling was used to predict health anxiety and a range of secondary health outcomes from motivation assessments. RESULTS: Where patients were more actively engaged in discussion of positive changes during session two, greater outcome improvements ensued in health anxiety and all secondary outcomes. Conversely, larger proportions of session two spent describing problems predicted poorer outcomes. Therapist and patient assessments of motivation did not predict health anxiety, but therapist assessments of client confidence and motivation predicted all secondary outcomes. CONCLUSIONS: Motivation remains an important process in CBT when delivered remotely, and motivational factors may predict outcomes more consistently from in-session interactions, compared to self-reports.

Does mesoscopic elasticity control viscous slowing down in glassforming liquids?

The dramatic slowing down of relaxation dynamics of liquids approaching the glass transition remains a highly debated problem, where the crux of the puzzle resides in the elusive increase in the activation barrier ΔE(T) with decreasing temperature T. A class of theoretical frameworks-known as elastic models-attribute this temperature dependence to the variations of the liquid's macroscopic elasticity, quantified by the high-frequency shear modulus G∞(T). While elastic models find some support in a number of experimental studies, these models do not take into account the spatial structures, length scales, and heterogeneity associated with structural relaxation in supercooled liquids. Here, we propose and test the possibility that viscous slowing down is controlled by a mesoscopic elastic stiffness κ(T), defined as the characteristic stiffness of response fields to local dipole forces in the liquid's underlying inherent structures. First, we show that κ(T)-which is intimately related to the energy and length scales characterizing quasilocalized, nonphononic excitations in glasses-increases more strongly with decreasing T than the macroscopic inherent structure shear modulus G(T) [the glass counterpart of liquids' G∞(T)] in several computer liquids. Second, we show that the simple relation ΔE(T) ∝ κ(T) holds remarkably well for some computer liquids, suggesting a direct connection between the liquid's underlying mesoscopic elasticity and enthalpic energy barriers. On the other hand, we show that for other computer liquids, the above relation fails. Finally, we provide strong evidence that what distinguishes computer liquids in which the ΔE(T) ∝ κ(T) relation holds from those in which it does not is that the latter feature highly fragmented/granular potential energy landscapes, where many sub-basins separated by low activation barriers exist. Under such conditions, it appears that the sub-basins do not properly represent the landscape properties relevant for structural relaxation.

Isomorph Invariance of Higher-Order Structural Measures in Four Lennard-Jones Systems.

In the condensed liquid phase, both single- and multicomponent Lennard-Jones (LJ) systems obey the "hidden-scale-invariance" symmetry to a good approximation. Defining an isomorph as a line of constant excess entropy in the thermodynamic phase diagram, the consequent approximate isomorph invariance of structure and dynamics in appropriate units is well documented. However, although all measures of the structure are predicted to be isomorph invariant, with few exceptions only the radial distribution function (RDF) has been investigated. This paper studies the variation along isomorphs of the nearest-neighbor geometry quantified by the occurrence of Voronoi structures, Frank-Kasper bonds, icosahedral local order, and bond-orientational order. Data are presented for the standard LJ system and for three binary LJ mixtures (Kob-Andersen, Wahnström, NiY2). We find that, while the nearest-neighbor geometry generally varies significantly throughout the phase diagram, good invariance is observed along the isomorphs. We conclude that higher-order structural correlations are no less isomorph invariant than is the RDF.

Hidden Scale Invariance in Polydisperse Mixtures of Exponential Repulsive Particles.

Polydisperse systems of particles interacting by the purely repulsive exponential (EXP) pair potential are studied in regard to how structure and dynamics vary along isotherms, isochores, and isomorphs. The sizable size polydispersities of 23%, 29%, 35%, and 40%, as well as energy polydispersity 35%, were considered. For each system an isomorph was traced out covering about one decade in density. For all systems studied, the structure and dynamics vary significantly along the isotherms and isochores but are invariant to a good approximation along the isomorphs. We conclude that the single-component EXP system's hidden scale invariance (implying isomorph invariance of structure and dynamics) is maintained even when a sizable polydispersity is introduced into the system.

Predicting outcomes and sudden gains from initial in-session interactions during remote cognitive-behavioural therapy for severe health anxiety.

There has been a dramatic increase in remote psychotherapy since the onset of the COVID-19 crisis. There is also expected to be an increase in mental health problems in the wake of the COVID-19 pandemic. An increase in severe health anxiety (SHA) is particularly anticipated, for which cognitive-behavioural therapy (CBT) is a frontline treatment. However, it is unclear what interaction types are associated with outcome-improvement in remote-CBT (rCBT) for SHA. This study aimed to identify interaction types that predict outcomes and sudden gains in rCBT for SHA using initial therapy session content. Forty-eight participants in rCBT for SHA had interactions at their first sessions categorized and rated in terms of patient activation: an individual's confidence and ability to manage their health. Multilevel modelling assessed whether early interaction types predicted session-by-session wellbeing. For participants experiencing sudden gains (n = 12) interactions at the session directly prior to the gain were similarly categorized and rated. The scores were then compared with ratings for the preceding session. A smaller proportion of early sessions was taken up with problem descriptions among those with greater outcome improvements. There was also a significant reduction in the proportion of the session spent describing problems in the session directly prior to a sudden gain, as compared with the previous session. Conversely, clients with better outcomes made more positive evaluations of themselves and therapy, noticed more positive changes and made more contributions to structuring interactions at initial sessions. Specific early interaction types predict session-by-session outcomes and precede sudden gains in rCBT for SHA.

Genomic heterogeneity in core-binding factor acute myeloid leukemia and its clinical implication.

Core-binding factor (CBF) acute myeloid leukemia (AML) encompasses AML with inv(16)(p13.1q22) and AML with t(8;21)(q22;q22.1). Despite sharing a common pathogenic mechanism involving rearrangements of the CBF transcriptional complex, there is growing evidence for considerable genotypic heterogeneity. We comprehensively characterized the mutational landscape of 350 adult CBF-AML [inv(16): n = 160, t(8;21): n = 190] performing targeted sequencing of 230 myeloid cancer-associated genes. Apart from common mutations in signaling genes, mainly NRAS, KIT, and FLT3, both CBF-AML entities demonstrated a remarkably diverse pattern with respect to the underlying cooperating molecular events, in particular in genes encoding for epigenetic modifiers and the cohesin complex. In addition, recurrent mutations in novel collaborating candidate genes such as SRCAP (5% overall) and DNM2 (6% of t(8;21) AML) were identified. Moreover, aberrations altering transcription and differentiation occurred at earlier leukemic stages and preceded mutations impairing proliferation. Lasso-penalized models revealed an inferior prognosis for t(8;21) AML, trisomy 8, as well as FLT3 and KIT exon 17 mutations, whereas NRAS and WT1 mutations conferred superior prognosis. Interestingly, clonal heterogeneity was associated with a favorable prognosis. When entering mutations by functional groups in the model, mutations in genes of the methylation group (ie, DNMT3A, TET2) had a strong negative prognostic impact.

Levosimendan reduces segmental pulmonary vascular resistance in isolated perfused rat lungs and relaxes human pulmonary vessels.

INTRODUCTION: Levosimendan is approved for acute heart failure. Within this context, pulmonary hypertension represents a frequent co-morbidity. Hence, the effects of levosimendan on segmental pulmonary vascular resistance (PVR) are relevant. So far, this issue has been not studied. Beyond that the relaxant effects of levosimendan in human pulmonary vessel are unknown. We addressed these topics in rats' isolated perfused lungs (IPL) and human precision-cut lung slices (PCLS). MATERIAL AND METHODS: In IPL, levosimendan (10 µM) was perfused in untreated and endothelin-1 pre-contracted lungs. The pulmonary arterial pressure (PPA) was continuously recorded and the capillary pressure (Pcap) was determined by the double-occlusion method. Thereafter, segmental PVR, expressed as precapillary (Rpre) and postcapillary resistance (Rpost) and PVR were calculated. Human PCLS were prepared from patients undergoing lobectomy. Levosimendan-induced relaxation was studied in naïve and endothelin-1 pre-contracted PAs and PVs. In endothelin-1 pre-contracted PAs, the role of K+-channels was studied by inhibition of KATP-channels (glibenclamide), BKCa2+-channels (iberiotoxin) and Kv-channels (4-aminopyridine). All changes of the vascular tone were measured by videomicroscopy. In addition, the increase of cAMP/GMP due to levosimendan was measured by ELISA. RESULTS: Levosimendan did not relax untreated lungs or naïve PAs and PVs. In IPL, levosimendan attenuated the endothelin-1 induced increase of PPA, PVR, Rpre and Rpost. In human PCLS, levosimendan relaxed pre-contracted PAs or PVs to 137% or 127%, respectively. In pre-contracted PAs, the relaxant effect of levosimendan was reduced, if KATP- and Kv-channels were inhibited. Further, levosimendan increased cGMP in PAs/PVs, but cAMP only in PVs. DISCUSSION: Levosimendan reduces rats' segmental PVR and relaxes human PAs or PVs, if the pulmonary vascular tone is enhanced by endothelin-1. Regarding levosimendan-induced relaxation, the activation of KATP- and Kv-channels is of impact, as well as the formation of cAMP and cGMP. In conclusion, our results suggest that levosimendan improves pulmonary haemodynamics, if PVR is increased as it is the case in pulmonary hypertension.

Solid-like mean-square displacement in glass-forming liquids.

It was recently shown that the real part of the frequency-dependent fluidity for several glass-forming liquids of different chemistry conforms to the prediction of the random barrier model (RBM) devised for ac electrical conduction in disordered solids [Bierwirth et al., Phys. Rev. Lett. 119, 248001 (2017)]. Inspired by these results, we introduce a crystallization-resistant modification of the Kob-Andersen binary Lennard-Jones mixture for which the results of extensive graphics-processing-unit-based molecular-dynamics simulations are presented. We find that the low-temperature mean-square displacement is fitted well by the RBM prediction, which involves no shape parameters. This finding highlights the challenge of explaining why a simple model based on hopping of non-interacting particles in a fixed random energy landscape with identical minima can reproduce the complex and highly cooperative dynamics of glass-forming liquids.

Patient activation in psychotherapy interactions: Developing and validating the consultation interactions coding scheme.

OBJECTIVE: We describe the development of an instrument aiming to offer interaction-level feedback based on "patient activation": client confidence and perceived ability to manage their health. METHOD: Twenty-two session-transcripts from cognitive behavioral therapy with high-users of healthcare were analyzed thematically, producing themes describing in-session interactions. Themes were subcategorized using patient activation theory into high and low activation presentations. Two coders new to the process were trained to use this consultation interactions coding scheme (CICS). Inter-rater reliability (IRR), convergent validity, and clinical utility were assessed and illustrated with extreme cases. RESULTS: Good-to-excellent IRR was achieved. The CICS, therapeutic alliance, and therapist competence were correlated. Client engagement in session-structuring interactions correlated with outcome. The highest CICS scorer showed multiple outcome-improvements, the lowest scorer reported deteriorations. CONCLUSIONS: This study presents the CICS's psychometric properties and indicates the value of client engagement in session-structuring.

Extending the use of routine outcome monitoring: Predicting long-term outcomes in cognitive behavioral therapy for severe health anxiety.

Objective: Routine outcome monitoring (ROM) is a well-evidenced means of improving psychotherapy's effectiveness. However, it is unclear how meaningful ROM is for problems that span physical and mental health, such as severe health anxiety. Physical and mental health comorbidities are common amongst severe health anxiety sufferers and cognitive behavioral therapy (CBT) is a recommended treatment. Method: Seventy-nine participants received CBT for severe health anxiety in a clinical trial. The Outcome Rating Scale (ORS: a ROM assessment of wellbeing) was completed at each session. Multilevel modeling assessed whether last-session ORS predicted health anxiety and other outcomes over 12-month follow-up. Similar models were developed using health anxiety as a comparative outcome-predictor. Outcome-improvements of treatment-responders with sudden gains were compared to those of non-sudden-gainers. Results: Last-session ORS scores predicted all outcomes up to 12 months later, with a comparable predictive effect to health anxiety. Sudden-gainers on the ORS reported significantly greater improvement in depression, functioning, and wellbeing, but no difference in health anxiety or other measures. Conclusion: The ORS may be a feasible, overall estimate of health, functioning, and quality of life in psychotherapy for severe health anxiety. Sudden gains on the ORS may be clinically meaningful with respect to some long-term outcomes.