The therapy relationship, digital interventions, and their interaction.

This article serves as an introduction to a special section devoted to the psychotherapy relationship and digital interventions. The nature of the therapy relationship is explored, and the question is raised as to whether machines can have relationships with their users. Finally, an overview and synthesis of the articles in the special section is provided.

Skills and methods that work in psychotherapy: Observations and conclusions from the special issue.

We draw recommendations and conclusions from the articles presented in this special issue and the companion special section in Psychotherapy Research on evidence-based therapist skills and methods. For distal (end-of-treatment) outcome, 10 skills/methods were judged to be demonstrably effective (affirmation/validation, paradoxical interventions, homework, routine outcome monitoring, strength-based methods, emotional regulation, imagery rehearsal therapy and exposure relaxation and rescripting therapy for nightmares, meditation/mindfulness/acceptance, behavioral activation, cognitive restructuring) and four were probably effective (rupture repair, role induction, collaborative assessment methods, chairwork). For intermediate (postsession or midtreatment) outcome, one method was judged to be demonstrably effective (cognitive-experiential dreamwork) and two methods probably effective (paradoxical interventions, homework). For immediate (in-session) outcomes, five skills/methods were judged to be probably effective (in-dialog silences, extended silences, role induction, strength-based methods, and emotion regulation). For the rest of the immediate, intermediate, or distal outcomes for skills/methods, there was either no or insufficient research available upon which to base judgments. Possible harmful effects, diversity considerations, and research limitations are summarized. The article ends with training implications, therapeutic practices, and the formal conclusions of the interorganizational Task Force on Psychotherapy Skills and Methods that Work. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychoeducational Interventions in Children and Adolescents with Type-1 Diabetes: A Systematic Review / Las intervenciones psicoeducativas en los menores y adolescentes con diabetes tipo 1: una revisión sistemática

The effectiveness of psychoeducational interventions in children and adolescents with type 1 diabetes is unclear. A systematic review was developed in accordance with PRISMA. Relevant databases (Pubmed, Cochrane, PsycINFO, and PsyARTICLES) were analyzed. Articles of the last decade with type 1 diabetes population between 6 and 18 years participating in psychoeducational interventions were the inclusion criteria. Twenty studies were reviewed, and improvements were found in glycosylated hemoglobin, diabetes knowledge, and psychosocial variables. The results support the positive effect of these interventions. The characteristics that seem to be behind the success of these interventions are the design appropriate to the characteristics of the population, the participation of psychologist and educators, the continuity of the program over time, and the use of digital tools and interaction strategies. Further studies need to be carried out and replicated in different groups of children and adolescents.

Hay dudas acerca de la efectividad de las intervenciones psicoeducativas en menores y adolescentes con diabetes tipo 1, motivo por el cual se realizó una revisión sistemática de acuerdo con el protocolo PRISMA. Se analizaron distintas bases de datos (Pubmed, Cochrane, PsycINFO y PsyARTICLES) con los siguientes criterios de inclusión: artículos de los últimos diez años, con población con diabetes tipo 1 de edades comprendidas entre los 6 y 18 años que hubieran participado en cualquier intervención psicoeducativa. Se revisaron 20 estudios y los resultados mostraron una mejora en la hemoglobina glicosilada, en el conocimiento de la enfermedad y en algunas variables psicosociales tras estas intervenciones. Las características que parecen estar detrás del éxito de estas intervenciones psicoeducativas son el diseño adecuado a las características de la población, la participación de profesionales de la psicología y de la educación, la continuidad del programa en el tiempo y el uso de herramientas digitales y otras estrategias de interacción. Se destaca la necesidad de realizar más estudios y que sean replicados en diferentes grupos de menores y adolescentes.

Reminiscence therapy exhibits alleviation of anxiety and improvement of life quality in postoperative gastric cancer patients: A randomized, controlled study.

ABSTRACT: Although reminiscence therapy alleviates mental illness and improves quality of life in neurocognitive disorders patients, little study reports its clinical application in cancer patients. Thus, this study aimed to explore the effect of reminiscence therapy on anxiety, depression, quality of life, and survival profile in postoperative gastric cancer patients.One hundred sixty surgical gastric cancer patients were enrolled in this randomized, controlled study, then randomly assigned to Reminiscence therapy group (N = 80) and Control group (N = 80) as 1:1 ratio. The evaluation was carried at baseline (M0), month 3 (M3), month 6 (M6), month 9 (M9), and month 12 (M12) after intervention by Hospital Anxiety and Depression Scale and European Organization for Research and Treatment of Cancer quality of life Questionnaire-Core 30 (QLQ-C30). Furthermore, disease-free survival and overall survival were analyzed using follow-up data.Reminiscence therapy decreased HADS for anxiety score at M6, M9, and M12, decreased anxiety rate at M9 and M12 compared to control care; while it did not affect HADS for depression score or depression rate at any time-point. Also, reminiscence therapy raised QLQ-C30 global health status score at M12, reduced QLQ-C30 symptoms score at M6, while did not affect QLQ-C30 function score at any time-point compared to control care. Reminiscence therapy did not affect disease-free survival and overall survival, either. Further subgroup analyses (divided by age and gender) observed that the effect of reminiscence therapy seemed more obvious in patients with age ≤60 years and male patients.Reminiscence therapy exhibits alleviation of anxiety and improvement of quality of life in postoperative gastric cancer patients.

Quality measurement of out-patient neuropsychological therapy after stroke in Germany: definition of indicators and retrospective pilot study.

BACKGROUND: In contrast to the hospital setting, today little work has been directed to the definition, measurement, and improvement of the quality of out-patient medical and therapeutic care. We developed a set of indicators to measure the quality of out-patient neuropsychological therapy after stroke. METHODS: The indicators cover core and interdisciplinary aspects of out-patient neuropsychological work such as mediation of patients into social care in case of need. Selection of the quality-indicators was done together with a consensus group of out-patient therapists and supported by evidence, validity, reliability as well as estimated relevance and variability with the quality of care. The set of indicators was further tested in a retrospective cohort study. Anonymous data of 104 patients were collected from out-patient clinical records of five clinics between November 2017 and April 2018. Associations between process and outcome quality were estimated exploitatively. RESULTS: Results allowed for the identification of areas with greater variability in the quality of process care and indicated that attention training as recommended by current guidelines had the lowest overall rate for meeting the quality-aim (met in 44% of the cases). This was followed by time < 1 month until the start of therapy (63% met) and mediation into social care in case of need (65% met). We further observed that overall quality and involving relatives in the therapy was associated with higher rates of professional reintegration (p-value = 0.03). However, the need for mediation into social care was associated with a reduced chance for successful professional reintegration (p-value = 0.009). CONCLUSION: In conclusion, we describe a first set of quality indicators which cover different aspects of out-patient neuropsychological therapy and sufficient variability with care. First data further suggests that meeting the specified quality aims may indeed have relevant effects on outcomes.

Bipolar Disorders: Evaluation and Treatment.

Bipolar disorders are common, recurrent mental health conditions of variable severity that are difficult to diagnose. Affected individuals have higher rates of other mental health disorders, substance use disorders, and comorbid chronic medical illnesses. New diagnostic criteria and specifiers with attention on mixed features and anxious distress aid the physician in recognizing episode severity and prognosis. Physicians should consider bipolar disorder in any patient presenting with depression. Pharmacotherapy with mood stabilizers, such as lithium, anticonvulsants, and antipsychotics, is a first-line treatment that should be continued indefinitely because of the risk of patient relapse. Active lifestyle approaches include good nutrition, exercise, sleep hygiene, and proper weight management. Monotherapy with antidepressants is contraindicated during episodes with mixed features, manic episodes, and in bipolar I disorder. Ongoing management involves monitoring for suicidal ideation, substance use disorders, treatment adherence, and recognizing medical complications of pharmacotherapy. Psychotherapy is a useful adjunct to pharmacotherapy. Patients and their support systems should be educated about the chronic nature of this illness, possible relapse, suicidality, environmental triggers (e.g., seasonal light changes, shift work, other circadian disruption), and the effectiveness of early intervention to reduce complications.

E-mental health applications for depression: an evidence-based ethical analysis.

E-mental health applications (apps) are an increasingly important factor for the treatment of depression. To assess the risks and benefits for patients, an in-depth ethical analysis is necessary. The objective of this paper is to determine the ethical implications of app-based treatment for depression. An evidence-based ethical analysis was conducted. The material was meta-reviews and randomized control studies (RCTs) on app-based treatment. Based on the empirical data, an ethical analysis was conducted using the 3-ACES-approach by Thornicroft and Tansella. Apps may empower autonomy, offer an uninterrupted series of contacts over a period of time, show evidence-based benefits for patients with subclinical and mild-to-moderate-symptoms, are easily accessible, may be used for coordinating information and services within an episode of care, and are on the whole cost-effective. Their risks are that they are not suitable for the whole range of severity of mental illnesses and patient characteristics, show severe deficits in the data privacy policy, and a big variability in quality standards. The use of apps in depression treatment can be beneficial for patients as long as (1) the usefulness of an app-based treatment is assessed for each individual patient, (2) apps are chosen according to symptom severity as well as characteristics like the patient's level of self-reliance, their e-literacy, and their openness vis-à-vis apps, (3) manufacturers improve their privacy policies and the quality of apps.

Adjunctive Psychotherapy for Bipolar Disorder: A Systematic Review and Component Network Meta-analysis.

Importance: Several psychotherapy protocols have been evaluated as adjuncts to pharmacotherapy for patients with bipolar disorder, but little is known about their comparative effectiveness. Objective: To use systematic review and network meta-analysis to compare the association of using manualized psychotherapies and therapy components with reducing recurrences and stabilizing symptoms in patients with bipolar disorder. Data Sources: Major bibliographic databases (MEDLINE, PsychInfo, and Cochrane Library of Systematic Reviews) and trial registries were searched from inception to June 1, 2019, for randomized clinical trials of psychotherapy for bipolar disorder. Study Selection: Of 3255 abstracts, 39 randomized clinical trials were identified that compared pharmacotherapy plus manualized psychotherapy (cognitive behavioral therapy, family or conjoint therapy, interpersonal therapy, or psychoeducational therapy) with pharmacotherapy plus a control intervention (eg, supportive therapy or treatment as usual) for patients with bipolar disorder. Data Extraction and Synthesis: Binary outcomes (recurrence and study retention) were compared across treatments using odds ratios (ORs). For depression or mania severity scores, data were pooled and compared across treatments using standardized mean differences (SMDs) (Hedges-adjusted g using weighted pooled SDs). In component network meta-analyses, the incremental effectiveness of 13 specific therapy components was examined. Main Outcomes and Measures: The primary outcome was illness recurrence. Secondary outcomes were depressive and manic symptoms at 12 months and acceptability of treatment (study retention). Results: A total of 39 randomized clinical trials with 3863 participants (2247 of 3693 [60.8%] with data on sex were female; mean [SD] age, 36.5 [8.2] years) were identified. Across 20 two-group trials that provided usable information, manualized treatments were associated with lower recurrence rates than control treatments (OR, 0.56; 95% CI, 0.43-0.74). Psychoeducation with guided practice of illness management skills in a family or group format was associated with reducing recurrences vs the same strategies in an individual format (OR, 0.12; 95% CI, 0.02-0.94). Cognitive behavioral therapy (SMD, -0.32; 95% CI, -0.64 to -0.01) and, with less certainty, family or conjoint therapy (SMD, -0.46; 95% CI, -1.01 to 0.08) and interpersonal therapy (SMD, -0.46; 95% CI, -1.07 to 0.15) were associated with stabilizing depressive symptoms compared with treatment as usual. Higher study retention was associated with family or conjoint therapy (OR, 0.46; 95% CI, 0.26-0.82) and brief psychoeducation (OR, 0.44; 95% CI, 0.23-0.85) compared with standard psychoeducation. Conclusions and Relevance: This study suggests that outpatients with bipolar disorder may benefit from skills-based psychosocial interventions combined with pharmacotherapy. Conclusions are tempered by heterogeneity in populations, treatment duration, and follow-up.

Personality Assessment and Psychotherapy Preferences: Congruence between Client Personality and Therapist Personality Preferences.

Consideration of client preferences has been emphasized as important to therapeutic outcomes, such as treatment engagement and retention. Although studies have investigated several client and therapist characteristics associated with client preferences, few have considered whether people have preferences regarding a potential therapist's personality. The current study extended prior research on client preferences by examining the influence of participants' Big Five personality traits on preferences for therapist personality characteristics utilizing latent profile analysis. We expected congruence between client personality traits and preferred psychotherapist personality traits. In both undergraduate and community samples, results indicated that participants generally prefer a psychotherapist with personality characteristics similar to their own. Our findings establish the presence of preferences based on personality factors and have implications for future research directions and the role of personality assessment in routine clinical practice.

Circulating cytokine levels in the treatment of comorbid anxiety disorders.

Psychotherapy research aims to investigate predictors and moderators of treatment outcome, but there are few consistent findings. This study aimed to investigate cytokines in patients undergoing treatment for anxiety disorders and whether the level of cytokines moderated the treatment outcome. Thirty-seven patients with comorbid and treatment-resistant anxiety disorders were investigated using multilevel modelling. Serum cytokine levels were measured three times: pretreatment, in the middle of treatment, and at the end of treatment. Anxiety and metacognitions were measured weekly throughout treatment by self-report. The levels of monocyte chemoattractant protein-1, tumour necrosis factor-alpha, and interleukin-1 receptor antagonist did not change during therapy or were not related to the level of anxiety. Metacognitive beliefs predicted anxiety, but the relationship between metacognitions and anxiety was not moderated by cytokines. Limitations of the study include that the patients were not fasting at blood sampling, and we did not assess body mass index, which may affect cytokine levels. The lack of significance for cytokines as a predictor or moderator may be due to a lack of power for testing moderation hypotheses, a problem associated with many psychotherapy studies. Cytokines did not predict the outcome in the treatment of comorbid anxiety disorders in our sample. Furthermore, cytokines did not moderate the relationship between metacognitions and anxiety.

Determining the therapist's contribution in therapist multicultural competence process and outcome.

Efforts to help therapists improve their multicultural competence (MCC) rely on measures that can distinguish between different levels of competence. MCC is often assessed by asking clients to rate their experiences with their therapists. However, differences in client ratings of therapist MCC do not necessarily provide information about the relative performance of therapists and can be influenced by other factors including the client's own characteristics. In this study, we used a repeated measures design of 8,497 observations from 1,458 clients across 35 therapists to clarify the proportion of variability in MCC ratings attributed to the therapist versus the client and better understand the extent that an MCC measure detects therapist differences. Overall, we found that a small amount of variability in MCC ratings was attributed to the therapist (2%) and substantial amount attributed to the client (70%). These findings suggest that our measure of MCC primarily detected differences at the client level versus therapist level, indicating that therapist MCC scores were largely dependent on the client. Clinical implications and recommendations for future MCC research and measurement are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

[The abolition of the expertise procedure for outpatient psychotherapy - A reduction of quality in the psychotherapy?] / Zur Abschaffung des Gutachterverfahrens in der Vertragspsychotherapie ­ ein Qualitätsverlust?

The abolition of the expertise procedure for outpatient psychotherapy - A reduction of quality in the psychotherapy? Abstract. Objectives: This article investigates whether or not the abolishment of the expertise procedure for an outpatient psychotherapy is a reliable quality feature; and whether or not the elimination of this procedure results in a reduction of quality in outpatient psychotherapy. Methods: We conducted a literature research that considered articles written between the years 2000 and 2020 dealing with the expertise procedure as a quality standard of outpatient psychotherapy. In order to discuss the different views of the cited authors, we also refer to further literature. Results: The expertise procedure is not a reliable quality feature of outpatient psychotherapy. The idea that abolishing the expertise procedure results in a reduction of quality in outpatient psychotherapy is not confirmed by the studies summarized.

Understanding personalized dynamics to inform precision medicine: a dynamic time warp analysis of 255 depressed inpatients.

BACKGROUND: Major depressive disorder (MDD) shows large heterogeneity of symptoms between patients, but within patients, particular symptom clusters may show similar trajectories. While symptom clusters and networks have mostly been studied using cross-sectional designs, temporal dynamics of symptoms within patients may yield information that facilitates personalized medicine. Here, we aim to cluster depressive symptom dynamics through dynamic time warping (DTW) analysis. METHODS: The 17-item Hamilton Rating Scale for Depression (HRSD-17) was administered every 2 weeks for a median of 11 weeks in 255 depressed inpatients. The DTW analysis modeled the temporal dynamics of each pair of individual HRSD-17 items within each patient (i.e., 69,360 calculated "DTW distances"). Subsequently, hierarchical clustering and network models were estimated based on similarities in symptom dynamics both within each patient and at the group level. RESULTS: The sample had a mean age of 51 (SD 15.4), and 64.7% were female. Clusters and networks based on symptom dynamics markedly differed across patients. At the group level, five dynamic symptom clusters emerged, which differed from a previously published cross-sectional network. Patients who showed treatment response or remission had the shortest average DTW distance, indicating denser networks with more synchronous symptom trajectories. CONCLUSIONS: Symptom dynamics over time can be clustered and visualized using DTW. DTW represents a promising new approach for studying symptom dynamics with the potential to facilitate personalized psychiatric care.

Escuchando al placebo, o cómo averiguar por qué funcionan los tratamientos / Listening to the placebo, or how to find out why treatments work

El efecto placebo es poderoso y ha demostrado su eficacia en múltiples estudios, compitiendo incluso con tratamientos bien establecidos. Esto pone de manifiesto un efecto en absoluto inerte o inespecífico. Tiene una naturaleza ubicua y da razón de todo tipo de tratamientos, si bien es la psicología el ámbito que le hace comprensible. Desgranar y conocer qué le hace tan eficaz es una tarea útil e ilustrativa de cómo operan los tratamientos al uso. En este sentido hay que destacar que para que opere debe ser construido en términos contextuales, no requiere de engaños y sí de una persona con problemas, en desequilibrio homeostático. El estudio de las condiciones en que el efecto placebo ocurre ha sido útil para delinear qué aspectos son importantes en los tratamientos, a saber: la facilitación de información y el sentido de ésta, las experiencias previas y las creencias del paciente, la aplicación del tratamiento en condiciones favorables y el uso de tratamientos bien reconocidos y aceptados en sus fundamentos y procedimiento

The placebo effect is powerful and has been proved effective in multiple studies, competing even with well-established treatments. It is not an unspecific or inert effect. It has a ubiquitous nature and accounts for all types of treatments, although psychology is the area that makes it comprehensible. Discussing and discovering what makes it so effective is a useful and illustrative task regarding how treatments work. In this sense, it must be emphasized that in order for the placebo effect to operate, it must be considered from contextual view, it does not require deception, and it does require a person with problems, in homeostatic imbalance. The study of the conditions in which the placebo effect occurs has been useful in delineating which aspects are important in treatments. These are as follows: the provision of information and its meaning, the patient's previous experiences and beliefs, the application of the treatment under favorable conditions, and the use of well-recognized and accepted treatments in their foundations and procedure

¿Psicoterapias perjudiciales? Comencemos por las malas prácticas / Harmful psychotherapies? Let's start with malpractice

Una vez resuelto el debate eysenckiano sobre la utilidad de la psicoterapia, sobrevino la controversia sobre las eficacias relativas de cada método. Superado parcialmente este último con el traslado de la investigación sobre la eficacia a la de la cualidad de la alianza terapéutica, ha surgido recientemente en España la pregunta sobre la eventual nocividad de algunas psicoterapias. En este texto incluiremos consideraciones tanto en el nivel científico como deontológico como de la práctica profesional de la psicoterapia

After the Eysenck debate on the usefulness of psychotherapy was resolved, professional psychotherapists witnessed seething controversy over the relative efficacy of each method. Having mostly overcome this argument and moved on from the research on efficacy to that on the quality of the therapeutic alliance, once again clinicians in Spain are observing the issue about the potential harmfulness of some therapeutic treatments. In this text, considerations will be developed both at the scientific and the deontological level, from the point of view of the professional practice of psychotherapy

Psicoterapias y pseudoterapias en búsqueda de la evidencia científica. La ciencia y la práctica profesional en Psicología Clínica / Psychotherapies and pseudo-therapies in search of scientific evidence. Science and professional practice in Clinical Psychology

La psicología está considerada una disciplina científica, pero algunas de sus especialidades, como la psicología clínica, tienen importantes dificultades para aplicar el método científico y trasladar los resultados de la investigación experimental al contexto profesional. Esta situación es especialmente problemática cuando multitud de teorías hacen que proliferen numerosos tratamientos psicológicos y que se sustente la idea (¿equivocada?) de que todos funcionan. El enfrentamiento entre posicionamientos basados en los aspectos comunes de las psicoterapias, en confrontación con los centrados en las técnicas, ha facilitado el camino y la expansión de pseudoterapias y la confusión de la población en general. Todo esto ocurre dentro de un contexto en el que ya existía un importante desencuentro entre la ciencia y la práctica clínica que afecta a muchos ámbitos profesionales de la psicología. El debate sobre los tratamientos y la asunción de que todos son eficaces permite mantener una actitud permisiva ante el uso de cualquier tratamiento, a veces avalados por algunas universidades, colegios profesionales y sociedades científico-profesionales, sin establecer restricciones a la difusión de propuestas pseudocientíficas, que no han sido sometidas a contraste empírico. En este trabajo presentamos un análisis del estado actual del tema y debatimos algunos de los aspectos más importantes

Psychology is considered to be a scientific discipline, but some of its specialties, such as clinical psychology, have significant difficulties in applying the scientific method, and in transferring the results of experimental research into the professional context. This situation is especially problematic when a multitude of theories fosters the proliferation of numerous treatments, as well as the (erroneous?) idea that all of them work. The confrontation between stances based on the common aspects of psychotherapies and those focused on techniques has opened up a path for pseudo-therapies and their expansion, along with the confusion of the general population. This situation takes place within a context in which there was already significant disagreement between science and clinical practice that impacts many professional areas within psychology. The debate about the efficacy and the assumption that all treatments are effective enables the maintaining of a permissive attitude towards the use of any treatment, sometimes even supported by some universities, professional associations, and scientific-professional societies, without restraints on the dissemination of pseudoscientific proposals that have not yet been empirically tested. This work analyzes the current state and discusses some of its most important aspects