Psychometric properties of the Affect Phobia Test.

The aim of this study was to make the first evaluation of the psychometric properties of the Affect Phobia Test, using the Swedish translation - a test developed to screen the ability to experience, express and regulate emotions. Data was collected from a clinical sample (N = 82) of patients with depression and/or anxiety participating in randomized controlled trial of Internet-based affect-focused treatment, and a university student sample (N = 197). The internal consistency for the total score was satisfactory (Clinical sample α = 0.88/Student sample α = 0.84) as well as for all the affective domains, except Anger/Assertion (α = 0.44/0.36), Sadness/Grief (α = 0.24/0.46) and Attachment/Closeness (α = 0.67/0.69). Test retest reliability was satisfactory (ICC > 0.77) for the total score and for all the affective domains except for Sadness/Grief (ICC = 0.04). The exploratory factor analysis resulted in a six-factor solution and did only moderately match the test's original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. As expected, the Affect Phobia test showed negative significant correlations in the clinical group with measures on depression (rxy  = -0.229; p < 0.01) and anxiety (rxy  = -0.315; p < 0.05). The conclusion is that the psychometric properties are satisfactory for the total score of the Affect Phobia Test but not for some of the test's affective domains. Consequently the domains should not be used as subscales. The test can discriminate between individuals who seek help for psychological problems and those who do not.

Orienting patient to affect, sense of self, and the activation of affect over the course of psychotherapy with cluster C patients.

This article investigates whether patients' sense of self and therapists' interventions aimed at orienting patients toward affect produce an affective activation in the patient. Both the independent contribution of sense of self and therapist intervention, as well as sense of self's moderating effect on therapist interventions, were investigated. Fifty cluster C patients were analyzed using 2 psychotherapy process measures and multilevel modeling. The results indicate that patients' affect experience increases over time. Both the therapist orienting the patient toward affect and the patient's sense of self predicted affect activation for the within-person effect (i.e., the patient's or therapist's standing in any given session relative to his or her baseline), but only sense of self was significant for the between-person effect (i.e., the patient's standing relative to all other patients). The relationship between a therapist orienting the patient toward affect and the patient's affective response was moderated by the patient's sense of self. The results have implications for therapists who want their patients to experience affect in a session.

Growth in sense of self and sense of others predicts reduction in interpersonal problems in short-term dynamic but not in cognitive therapy.

OBJECTIVES: We investigated relationships between sense of self (SoS) and sense of others (SoO) and specific interpersonal problems in short-term dynamic and cognitive therapy. METHOD: 40 patients with Cluster C personality disorders from a RCT were included. The Achievement of Therapeutic Objective Scales (ATOS) was used to perform ratings of videotaped sessions. The Inventory of Interpersonal Problems Circumplex version was used as the outcome measure. RESULTS: There were significant relationships between growth in SoS and SoO and reductions of hostile-dominant and hostile-submissive behaviors, as well as cold, social-avoidant and vindictive behaviors. Increase in SoO was also related to reductions in non-assertive and domineering behaviors. However, the results were only present in the STDP treatment group.

Can two psychotherapy process measures be dependably rated simultaneously? A generalizability study.

Observer ratings in psychotherapy are a common way of collecting information in psychotherapy research. However, human observers are imperfect instruments, and their ratings may be subject to variability from several sources. One source of variability can be raters' assessing more than 1 instrument at a time. The purpose of this research is to investigate whether it is possible to have raters assess 2 different psychotherapy process measures simultaneously and still produce dependable scores. Two studies were designed. The first compared scores assessed by raters who rated either 1 instrument or 2 instruments simultaneously. The second compared scores of raters who assessed 2 instruments simultaneously and scores of expert raters who assessed 1 instrument. The results show that variability in scores is largely due to differences across the object of measurement (e.g., patients). Small variability was reported for raters, raters' interaction with patients, and whether the rater assessed 1 instrument or 2 instruments simultaneously. The results are promising for the quality of observer ratings of psychotherapy process and for the feasibility of future psychotherapy process research. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Properties of the Achievement of Therapeutic Objectives Scale (ATOS): a Generalizability Theory study.

The psychometric properties of the process instrument Achievement of Therapeutic Objectives Scale (ATOS) were examined in this study. Generalizability Theory (GT) was used to evaluate variability attached to several possible sources of error. A random sample of 24 psychotherapy sessions was selected from a larger RCT trial including Cluster C patients and rated in different rating conditions (rating all scales versus rating a subgroup of the scales). Two G-study designs were used to compute variance components and generalizability coefficients. The results provided evidence that the ATOS is sensitive to differences among patients and to differences among subscales within patients (i.e., to different constructs within the ATOS). Rating condition contributed much to variability in scores when the ATOS scales were examined separately, but this variability was negligible when all scales were included in the same analysis. There was little variability due to raters, which indicates that adequately trained raters are able to apply the ATOS without contributing to measurement error.

Experience of affects predicting sense of self and others in short-term dynamic and cognitive therapy.

The present study examined whether levels of activating affects (AA) and inhibitory affects (IA) were related to change toward more compassionate and realistic levels of sense of self (SoS) and sense of others (SoO). The sample included 47 patients diagnosed with cluster C personality disorders, who received 40 sessions of either cognitive therapy or short-term dynamic therapy (see the randomized controlled trial study, Svartberg, Stiles, & Seltzer, 2004). A total of 927 videotaped sessions were rated with the use of the observational instrument, Achievement of Therapeutic Objectives Scale. Longitudinal multilevel modeling enabled the examination of both between-person effects and within-person changes in level of AA and IA. Patients with better ability to experience AA at the start of therapy displayed significantly higher SoS and SoO across sessions compared with other patients. Patients who experienced higher levels of IA at the start of therapy displayed lower levels of SoS across sessions. A patient experiencing more AA than usual for him/her self within a session predicted an increased level of SoS and SoO at the next measuring point. There were no different change patterns in the 2 treatment groups. Results suggest that focus within therapy sessions on increasing patients' AA can help facilitate change in SoS and SoO toward more compassionate and realistic quality.

Different processes for different therapies: therapist actions, therapeutic bond, and outcome.

Therapeutic bond, as a component of the alliance, is considered a common factor in psychotherapy; however, it may operate differently in various treatments. This article investigates therapist actions, particularly affect focus, in the formation of the bond and on reduction of symptoms in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT) for cluster C patients. Forty-six cases (23 STDP and 23 CT) were assessed using the Psychotherapy Process Q-Sort, the Helping Alliance Questionnaire, and the Symptom Checklist 90. These scores were used to determine (a) therapist actions that predict formation of the bond, (b) the relation of the bond to symptom reduction, and (c) how therapist actions and bond interacted to reduce symptoms. Multiple regressions were applied to the total sample and to the STDP and CT cases. Psychotherapy Process Q-Sort items describing avoidance of affects were positively related to the bond in the total sample, STDP and CT. However, the relation between therapist actions, bond, and symptom reduction differed for the two treatments. For STDP, avoidance of affect suppressed the relation of bond to symptom reduction and also negatively influenced symptom reduction. On the other hand, in CT, avoidance of affect was positively related to both the formation of the bond and to symptom reduction. Although the bond is a common factor and important component of the alliance, it appears to operate differently in STDP and CT. A focus on affect is important to the benefits of STDP but interferes with the benefits of CT.

Learning how to rate video-recorded therapy sessions: a practical guide for trainees and advanced clinicians.

Watching and rating psychotherapy sessions is an important yet often overlooked component of psychotherapy training. This article provides a simple and straightforward guide for using one Website (www.ATOStrainer.com) that provides an automated training protocol for rating of psychotherapy sessions. By the end of the article, readers will be able to have the knowledge to go to the Website and begin using this training method as soon as they have a recorded session to view. This article presents, (a) an overview of the Achievement of Therapeutic Objectives Scale (ATOS; McCullough et al., 2003a), a research tool used to rate psychotherapy sessions; (b) a description of APA training tapes, available for purchase from APA Books, that have been rated and scored by ATOS trained clinicians and posted on the Website; (c) step-by-step procedures on how ratings can be done; (d) an introduction to www.ATOStrainer.com where ratings can be entered and compared with expert ratings; and (e) first-hand personal experiences of the authors using this training method and the benefits it affords both trainees and experienced therapists. This psychotherapy training Website has the potential to be a key resource tool for graduate students, researchers, and clinicians. Our long-range goal is to promote the growth of our understanding of psychotherapy and to improve the quality of psychotherapy provided for patients.