Interpersonal factors in internet-based cognitive behavioral therapy for depression: Attachment style and alliance with the program and with the therapist.

Objective This open-trial study examined effects of a culturally-adapted Hebrew version of guided internet-based cognitive behavioural therapy (ICBT) for depression. We examined therapeutic alliance with the therapist and with the programme (content) as potential predictors of outcomes. Furthermore, we examined whether anxious and avoidant attachment styles improved, although relationships were not the focus of treatment. Method: We examined alliance with therapist and alliance with programme and their time-lagged (1 week), longitudinal relationship with depression outcomes, and change in anxious and avoidant attachment during treatment. Results: Depression and insomnia improved significantly (Cohen's d: depression = 1.34, insomnia = 0.86), though dropout was relatively high (49%). Alliance with programme and with the therapist predicted adherence and dropout, whereas only alliance with therapist predicted symptom improvement. Avoidant attachment decreased over treatment whereas anxious attachment did not. Conclusion: A culturally-adapted version of ICBT for depression showed that alliance with therapist and alliance with programme both can play an important role in its effectiveness: alliance with programme and the therapist drive adherence and dropout and alliance with therapist is related to symptom improvement. Although the focus of treatment is not interpersonal, avoidant attachment style can improve following ICBT.

Patient alliance with the program predicts treatment outcomes whereas alliance with the therapist predicts adherence in internet-based therapy for panic disorder.

This study examines relationships among different aspects of therapeutic alliance with treatment outcome, adherence and attrition in internet delivered cognitive behavioral therapy (ICBT) for panic disorder.We examined alliance-outcome relationships in ICBT (N = 74) using a newly developed self-report alliance measure that disentangles alliance with program content (Internet Patient's Experience of Attunement and Responsiveness with the program; I-PEARp) and with the therapist (I-PEARt). We compared ICBT outcomes of patient rated and therapist-rated alliance with conventional alliance scales (WAI-6 and WAI-T).Consistent with our hypothesis, I-PEARp and I-PEARt distinguished between different aspects of the alliance and predicted outcomes better than standard alliance scales. Furthermore, higher ratings of I-PEARp were associated with subsequent lower symptoms and lower symptoms were associated with higher subsequent alliance. In contrast, I-PEARt predicted adherence, but not symptoms. Although therapists' ratings of alliance (thI-PEAR) improved significantly during treatment, they did not predict subsequent symptoms, adherence, or dropout.Results indicate that the patient experience of the alliance in ICBT includes two aspects, each of which uniquely contributes to outcomes; patient connection to the program is related to symptom outcomes whereas the dyadic relationship with the therapist serves as the glue to allow the treatment to hold.

Effects of rumination and distraction on inhibition.

BACKGROUND AND OBJECTIVES: Rumination involves fixating on negative content, is associated with biases in inhibitory control, and typically worsens negative mood. In contrast, distraction attempts to engage attentional control and downregulate negative mood. To date studies have not dissociated the detrimental effects of rumination from beneficial effects of distraction on individuals' ability to inhibit irrelevant negative information. Moreover, research has not examined the possible pathways connecting rumination and distraction, negative mood and inhibitory control. METHODS: To bridge these gaps, we report two studies that assess the effect of induced rumination versus distraction on inhibitory control among high ruminators. RESULTS: In Study 1 distraction improved inhibition of negative content, whereas induced rumination impaired inhibition of negative content. Study 2 replicated Study 1 and demonstrated that the effect of distraction on inhibition of negative content was mediated by changes in negative mood. LIMITATIONS: Our studies are limited by small sample sizes and lack of measurement of possible long-term effects. CONCLUSIONS: Our findings provide preliminary evidence for an effect of mood on inhibition and not vice versa, among high ruminators. We discuss theoretical and clinical implications of these findings.

Development and validation of a State-Reappraisal Inventory (SRI).

Reappraisal is a multifaceted construct associated with a wide range of proximal (e.g., affective responses) and distal (e.g., psychopathology) consequences. To date, our understanding of use of reappraisal is based either on self-reports of tendencies to use a specific strategy in general or in the last week or on performance on lab-based tasks. There has been little effort to measure use of reappraisal immediately following an emotionally evocative situation (i.e., state-reappraisal). To close this gap, we developed the State-Reappraisal Inventory (SRI) that ascertains use of reappraisal immediately after an emotional event. In Study 1, exploratory factor analyses yielded two reliable subscales measuring state levels of construal of an emotion-eliciting situating as more positive (Increase Positive) and less negative (Decrease Negative). In two further studies, confirmatory factor analyses using a bifactor model provided a good fit for the data and surpassed three competing models. In a fourth study, the SRI showed sensitivity to experimentally induced state changes in reappraisal. Across studies, the questionnaire demonstrated good convergent and discriminant validity. Thus, the SRI is a new measure of state-reappraisal that can allow researchers and clinicians to examine the extent to which individuals use reappraisal in emotional situations. (PsycINFO Database Record (c) 2018 APA, all rights reserved).