Basic counseling skills in psychology and teaching: validation of a short version of the counselor activity self-efficacy scales.

BACKGROUND: Counseling self-efficacy is a relevant measure to examine trainees' beliefs about their counseling skills. This study aimed to validate three scales of the revised German version of the Counselor Activity Self-Efficacy Scales (CASES-R) measuring basic counseling skills. To ascertain the scales' sensitivity to change, counseling self-efficacy was assessed before and after specific training. METHOD: The sample comprised 163 university students enrolled either in psychology or education. Students were examined before and after participating in training focusing on basic counseling skills. We applied confirmatory factor analysis and tested internal consistency, convergent validity, and criterion validity. RESULTS: Confirmatory factor analysis supported the three-factor structure of the CASES-R scales for basic counseling skills. The scales provided acceptable to good internal consistency (α = 0.77 - 0.87). Significant relations with general self-efficacy (r =.23, p <.01) provided first indication for convergent validity. We also found a significant correlation of the CASES-R with positive affect (r =.22), and significant correlations of some subscales with empathetic concern (r =.16 -.21) and mastery goal orientation (r =.16), overall supporting criterion validity. The CASES-R scales proved to be sensitive to change, as participants' scores were higher after (M = 6.18, SD = 1.05) than before (M = 5.37, SD = 1.16) counseling training (F(1, 309) = 42.27, p <.001). CONCLUSION: We found support for the proposed factor structure and reliability of the German version of the three CASES-R scales, indicating its suitability for use in basic counseling settings. Future research should further examine the scales' validity.

Exposure therapy for health anxiety: Effectiveness and response rates in routine care of an outpatient clinic.

OBJECTIVE: Many randomized controlled trials (RCTs) have demonstrated the efficacy and benefits of exposure therapy in the treatment of health anxiety. However, the application of these research results to routine care has not been considered sufficiently. The aim of this study is to analyze the effectiveness of exposure therapy in the routine treatment of health anxiety patients. METHOD: Data were available for 35 patients, who repeatedly filled in comprehensive general questionnaires, and those specific to health anxiety. RESULTS: The data analysis showed that health anxiety symptoms decreased significantly both posttreatment (Cohen's d = 0.97-1.00) and at follow-up (Cohen's d = 1.33-1.34). In addition, the scores of depressiveness, somatic symptoms, and psychological distress showed improvements with effect sizes of d = 0.35-0.51. Regarding the primary outcome measures for health anxiety, response rates were 51%-63%, and remission rates were 29%-43%. CONCLUSION: Exposure therapy is effective and sustainable regarding the treatment of health anxiety, even under naturalistic conditions, whereas response and remission rates are lower than for RCT.

What characterizes helpful personal practice in psychotherapy training? Results of an online survey.

BACKGROUND: Personal practice (PP) is often considered as a central component in psychotherapy training aiming to promote personal and therapeutic competences. However, its implementation varies considerably in practice. AIMS: The purpose of this exploratory study was to examine the current practice of PP regarding the frequency/occurrence and perceived usefulness/impairment of topics, techniques and effects, as well as its helpful characteristics in psychotherapy training. METHOD: 407 German psychotherapy trainees (214 cognitive behavioural therapy; 178 psychodynamic therapy) were surveyed online as to their current practice of PP. RESULTS: For trainees, personal and therapeutic related topics were discussed. Reflection techniques and self-experiential practice were among the most frequently reported strategies, while the fostering of personal and interpersonal competences was among the effects with the strongest occurrence. However, negative PP effects were recorded as well. Differences in PP practice emerged between therapeutic orientations. CONCLUSIONS: As certain techniques which are central to PP (e.g. self-experience) were also rarely or not used, and negative effects reported, its potential might not be fully utilized.

Differences in psychotherapy preferences between psychotherapy trainees and laypeople.

Despite increasing research on psychotherapy preferences, the preferences of psychotherapy trainees are largely unknown. Moreover, differences in preferences between trainees and their patients could (a) hinder symptom improvement and therapy success for patients and (b) represent significant obstacles in the early career and development of future therapists.We compared the preferences of n = 466 psychotherapy trainees to those of n = 969 laypersons using the Cooper-Norcross Inventory of Preferences. Moreover, we compared preferences between trainees in cognitive-behavioural therapy (CBT) and psychodynamic trainees.We found significant differences between both samples in 13 of 18 items, and three of four subscales. Psychotherapy trainees preferred less therapist directiveness (d = 0.58), more emotional intensity (d = 0.74), as well as more focused challenge (d = 0.35) than laypeople. CBT trainees preferred more therapist directiveness (d = 2.00), less emotional intensity (d = 0.51), more present orientation (d = 0.76) and more focused challenge (d = 0.33) than trainees in psychodynamic/psychoanalytic therapy.Overall, the results underline the importance of implementing preference assessment and discussion during psychotherapy training. Moreover, therapists of different orientations seem to cover a large range of preferences for patients, in order to choose the right fit.

Modeling in psychotherapy training: A randomized controlled proof-of-concept trial.

OBJECTIVE: Despite the importance of modeling for learning, it has only so far been investigated in a few controlled studies in psychotherapy training. We, therefore, investigated, across several study outcomes, whether modeling outperformed a control group. METHOD: Sixty-nine trainees (i.e., psychology students; mean age 25.58 years, 81.2% women and 81.2% Caucasian) were randomly assigned to the intervention group (IG, manual reading plus modeling) or control group (CG, manual reading). After manual reading, IG participants watched a video of a skillfully conducted therapy session, whereas CG participants watched an unspecific tutorial (e.g., solving a Rubik's Cube). Trainees then demonstrated cognitive behavioral interventions in videotaped role-plays with (SPs). Psychotherapeutic competences and counseling skills were rated by two independent raters, on the Cognitive Therapy Scale (CTS) and the Clinical Communication Skills Scale-Short Form (CCSS-S). In addition, raters, trainees, and SPs assessed empathy (Empathy Scale [ES]) and alliance (Helping Alliance Questionnaire [HAQ]). RESULTS: Multilevel modeling revealed Significant Time × Group Effects, that is, psychotherapy competences (CTS, ß = .26, p = .026) and counseling skills (CCSS-S, ß = .31, p = .004) to increase more pre-post in the IG than in the CG (rater perspective). The same applied to the alliance (HAQ) from the external rater and SP perspectives. Trainees evaluated the alliance as improving in both groups from pre to post training (main effect). CONCLUSIONS: The results provide initial support for modeling as important for fostering psychotherapy skills. Future studies should focus on more complex training and real patient encounters. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The concise measurement of clinical communication skills: Validation of a short scale.

Objective: There is a lack of brief rating scales for the reliable assessment of psychotherapeutic skills, which do not require intensive rater training and/or a high level of expertise. Thus, the objective is to validate a 14-item version of the Clinical Communication Skills Scale (CCSS-S). Methods: Using a sample of N = 690 video-based ratings of role-plays with simulated patients, we calculated a confirmatory factor analysis and an exploratory structural equation modeling (ESEM), assessed convergent validities, determined inter-rater reliabilities and compared these with those who were either psychology students, advanced psychotherapy trainees, or experts. Results: Correlations with other competence rating scales were high (rs > 0.86-0.89). The intraclass correlations ranged between moderate and good [ICC(2,2) = 0.65-0.80], with student raters yielding the lowest scores. The one-factor model only marginally replicated the data, but the internal consistencies were excellent (α = 0.91-95). The ESEM yielded a two-factor solution (Collaboration and Structuring and Exploration Skills). Conclusion: The CCSS-S is a brief and valid rating scale that reliably assesses basic communication skills, which is particularly useful for psychotherapy training using standardized role-plays. To ensure good inter-rater reliabilities, it is still advisable to employ raters with at least some clinical experience. Future studies should further investigate the one- or two-factor structure of the instrument.

Corrigendum: Assessing Patient Preferences: Examination of the German Cooper-Norcross Inventory of Preferences.

[This corrects the article on p. 795776 in vol. 12, PMID: 35095681.].

Group cohesion in group-based personal practice.

BACKGROUND: Personal practice (PP) is an integral component of many psychotherapy training programmes. It aims to promote personal and professional growth and is often conducted in a group format (g-PP). Group cohesion is one of the most researched mechanisms in group psychotherapy, but has rarely been studied in the context of g-PP. AIMS AND METHOD: This exploratory study examines the associations between cohesion, satisfaction with g-PP, its impact on personal and professional development, and theoretical orientation in a sample of n = 329 German psychotherapy trainees. Cohesion was assessed with the group questionnaire (GQ-D; Positive Bonding, Positive Working, Negative Relationship). RESULTS: Overall, participants reported high levels of all outcome variables. Positive Bonding was the strongest predictor of satisfaction with g-PP (ß = 0.46, p<.001). While trainees in cognitive behaviour therapy reported significantly better cohesion scores (d≥0.31), trainees in psychodynamic therapy reported significantly higher satisfaction with g-PP and its impact on their developments (d≥0.30). CONCLUSIONS: Group cohesion appears to be an important factor in g-PP that should be actively promoted by group leaders. However, longitudinal study designs are needed to better understand the emergence of cohesion in g-PP as well as potential moderating factors.

[Anxiety about Health of Patients Suffering from Epilepsy]. / Krankheitsängste bei Epilepsiepatient*innen.

BACKGROUND: The presence of somatic diseases makes diagnosis of health-related anxiety difficult. Studies have shown that a significant proportion of patients suffering from somatic diseases also suffer from illness anxiety. OBJECTIVE: Patients suffering from epilepsy were examined, for whom no data regarding their illness anxiety had previously been obtained. METHOD: 76 epileptics were analyzed regarding their psychological distress (Mini-SCL), fear of recurrence (PA-F) and hypochondriacal traits (MIHT). RESULTS: In general, epileptics experienced the same level of distress and fear in comparison to a norm sample. At the same time, 28% (overall distress) to 45% (anxiety) of the study participants were observed to have abnormal values. The fear of recurrence was low in comparison to other somatic diagnosis groups. Hypochondriac traits were seen in 7% (perceptive) to 13% (affective/behavioral) of the respondents. CONCLUSION: An increased awareness of illness anxiety in patients can help improve healthcare and quality of life of epileptics.

Effects of competence feedback on therapist competence and patient outcome: A randomized controlled trial.

OBJECTIVE: Therapist competence is considered essential for the success of psychotherapy. Feedback is an intervention which has the potential to improve therapist competence. The present study investigated whether competence feedback leads to an improvement of therapist competence and patient outcome. METHOD: Sixty-seven master-level clinical trainees were randomly assigned to either a competence feedback group (CFG) or a control group (CG). Patients with a diagnosis of major depression (N = 114) were randomly assigned to CFG or CG. Treatment included 20 individual sessions of cognitive behavioral therapy (CBT). In CFG, therapists received, parallel to the treatment, five competence feedbacks, based on videotaped therapy sessions. Independent raters assessed therapist competence with the Cognitive Therapy Scale (CTS) and provided the competence feedback. Patient outcome was evaluated with the Beck Depression Inventory-II (BDI-II) and therapeutic alliance (Helping Alliance Questionnaire [HAQ]) from both therapist's (HAQ-T) and patient's (HAQ-P) perspective were evaluated after each of the 20 sessions. RESULTS: (a) Therapist competence (CTS) increased significantly more for CFG than CG. (b) Depression (BDI-II) decreased significantly across sessions for both groups, but without evidence for a group-differential benefit for the CFG. (c) Therapeutic alliance (HAQ-T/P) increased significantly across sessions for both groups from both perspectives, but without group differences. (d) There is a positive effect of BDI-II on CTS at the beginning and a negative effect of CTS on BDI-II at the end of therapy. CONCLUSION: Competence feedback improves therapists' independently rated competence, but there is no evidence that competence feedback in CBT leads to better outcome. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Communicating the diagnosis of cancer or depression: Results of a randomized controlled online study using video vignettes.

BACKGROUND: Communicating a diagnosis is highly important, yet complex, especially in the context of cancer and mental disorders. The aim was to explore the communication style of an oncologist vs. psychotherapist in an online study. METHODS: Patients (N = 136: 65 cancer, 71 depression) were randomly assigned to watch a standardized video vignette with one of two communication styles (empathic vs. unempathic). Outcome measures of affectivity, information recall, communication skills, empathy and trust were applied. RESULTS: Regardless of diagnosis, empathic communication was associated with the perception of a significantly more empathic (p < 0.001, ηpartial2  = 0.08) and trustworthy practitioner (p = 0.014, ηpartial2  = 0.04) with better communication skills (p = 0.013, ηpartial2  = 0.05). Cancer patients reported a larger decrease in positive affect (p < 0.001, ηpartial2  = 0.15) and a larger increase in negative affect (p < 0.001, ηpartial2  = 0.14) from pre- to post-video than depressive patients. Highly relevant information was recalled better in both groups (p < 0.001, d = 0.61-1.06). CONCLUSIONS: The results highlight the importance of empathy while communicating both a diagnosis of cancer and a mental disorder. Further research should focus on the communication of a mental disorder in association with cancer.

Recognizing obsessive-compulsive disorder: how suitable is the German Zohar-Fineberg obsessive-compulsive screen?

BACKGROUND: Despite the prevalence of obsessive-compulsive disorder (OCD), its precise identification remains challenging. With the Zohar-Fineberg Obsessive-Compulsive Screen (ZF-OCS; 5 or 6 items), a brief instrument is widely available mainly in English. As there is a lack of empirical studies on the ZF-OCS, the aim of the present study was to translate the items into German and investigate the instrument in a nonclinical sample. METHODS: In two consecutive online surveys, n = 304 and n = 51 students participated. Besides the ZF-OCS, they answered established measures on OCD, depression, health anxiety, general anxiety and health-related well-being. RESULTS: Whereas internal consistency was low (α = .53-.72; ω = .55-.69), retest reliability (rt1,t2 = .89) at two weeks was high. As expected, we found high correlations with other OCD instruments (r > .61; convergent validity), and significantly weaker correlations with measures of depression (r = .39), health anxiety (r = .29), and health-related well-being (r = -.28, divergent validity). Nonetheless, the correlations with general anxiety were somewhere in between (r = .52). CONCLUSIONS: Due to heterogeneous OCD subtypes, the ZF-OCS asks diverse questions which probably resulted in the present internal consistency. Nevertheless, the results on retest reliability and validity were promising. As for other OCD instruments, divergent validity regarding general anxiety seems problematic to establish. Even so, the ZF-OCS seems valuable for screening purposes, as it is short and easy to administer, and may facilitate initiating subsequent clinical assessment. Further studies should determine the instrument's diagnostic accuracy.

Assessment of Counseling Self-Efficacy: Validation of the German Counselor Activity Self-Efficacy Scales-Revised.

Background: Many authors regard counseling self-efficacy (CSE) as important in therapist development and training. The purpose of this study was to examine the factor structure, reliability, and validity of the German version of the Counselor Activity Self-Efficacy Scales-Revised (CASES-R). Method: The sample consisted of 670 German psychotherapy trainees, who completed an online survey. We examined the factor structure by applying exploratory and confirmatory factor analysis to the instrument as a whole. Results: A bifactor-exploratory structural equation modeling model with one general and five specific factors provided the best fit to the data. Omega hierarchical coefficients indicated optimal reliability for the general factor, acceptable reliability for the Action Skills-Revised (AS-R) factor, and insufficient estimates for the remaining factors. The CASES-R scales yielded significant correlations with related measures, but also with therapeutic orientations. Conclusion: We found support for the reliability and validity of the German CASES-R. However, the subdomains (except AS-R) should be interpreted with caution, and we do not recommend the CASES-R for comparisons between psychotherapeutic orientations.

Assessing Patient Preferences: Examination of the German Cooper-Norcross Inventory of Preferences.

Despite the positive effects of including patients' preferences into therapy on psychotherapy outcomes, there are still few thoroughly validated assessment tools at hand. We translated the 18-item Cooper-Norcross Inventory of Preferences (C-NIP) into German and aimed at replicating its factor structure. Further, we investigated the reliability of the questionnaire and its convergence with trait measures. A heterogeneous sample of N = 969 participants took part in our online survey. Performing ESEM models, we found acceptable model fit for a four-factor structure similar to the original factor structure. Furthermore, we propose an alternative model following the adjustment of single items. The German C-NIP showed acceptable to good reliability, as well as small correlations with Big-Five personality traits, trait and attachment anxiety, locus of control, and temporal focus. However, we recommend further replication of the factor structure and further validation of the C-NIP.

Research priorities set by people with OCD and OCD researchers: Do the commonalities outweigh the differences?

OBJECTIVE: In contrast to research agendas being predominantly set by scientists or funders, a collaborative approach was used to spot future goals for research on obsessive-compulsive disorder. METHODS: First, we conducted a meta-review and then compared the results of two online surveys with OCD professionals and patients on research priorities. The literature search was performed in three comprehensive databases, and ten research goals were extracted. Sixty-four patients and eight professionals responded to open questions on their five most important goals. Then, they ranked the ten aims extracted from the literature on a 6-point Likert scale. RESULTS: For patients and professionals, research on treatment gains that persist long-term was most important. Concerning the top five goals listed in an open format, for patients, development and maintenance of the disease was as important as psychotherapy and its efficacy. In contrast, for professionals, the efficacy and the optimization of psychotherapy were the far most important research goals. CONCLUSIONS: We proposed one possibility to involve patients in OCD research, and the multitude of answers presents a wealth of research ideas. PRACTICE IMPLICATIONS: Since consistent research involvement may contribute to its clinical impact, researchers are now invited to translate our findings into empirical studies.

Standardized patients in psychotherapy training and clinical supervision: study protocol for a randomized controlled trial.

BACKGROUND: Psychotherapy is highly effective and widely acknowledged for treating various mental disorders. Nevertheless, in terms of methods for teaching effective psychotherapeutic approaches and competencies, there has been a lack of investigation. Training and supervision are the main strategies for teaching therapist competencies, and standardized role-plays with simulated patients (i.e., trained individuals playing someone with a mental disorder) seem useful for evaluating training approaches. In medical education, this procedure is now internationally established. However, so far, little use has been made of standardized role-playing to evaluate training and supervision in the area of clinical psychology and psychotherapy. METHODS: In this study, standardized role-plays are used to evaluate methods for training and supervision. Central cognitive behavioral approaches for treating depression are taught in the training. The first experiment compares an active training approach (i.e., model learning) with a passive one (i.e., reading manual-based instructions). The second experiment compares a direct supervision technique (i.e., supervision based on video analysis) with an indirect one (i.e., supervision based on verbal reporting). In each experiment, 68 bachelor's and master's students of psychology will be randomly assigned to the experimental and control groups. Each student takes part in three role-plays (baseline, post and 3-month follow-up), which are all videotaped. Two independent raters assess therapist competencies in each role-play on the basis of a standardized competence scale. DISCUSSION: The research project aims to contribute to the development of specific training and supervision methods in order to improve psychotherapy training and patient care. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN19173895. Registered on 10 December 2019.

The heterogeneous course of OCD - A scoping review on the variety of definitions.

Although effective treatments exist, obsessive-compulsive disorder (OCD) is, according to the views of patients and experts, still associated with chronicity, a term with no clear and consistent definition. To improve patient care and to foster research, a clear distinction between the various concepts of chronicity cited in the literature is crucial. The aim was thus to explicate central concepts related to courses and trajectories in OCD based on an explorative, scoping search of the existing literature. Our review revealed a considerable lack in content validity, as the concepts were operationalized inconsistently. Concepts related to symptom improvement were (complete) recovery, partial/full remission and partial/full response. Terms used in relation with symptom stability or worsening were chronic/continuous, intermittent and episodic course, waxing and waning, relapse, recurrence, deterioration and treatment-refractoriness. All concepts are explained and visualized as a result of the review. Further, based on authors' remarks, we present recommendations on how to enhance care for chronic OCD patients, namely training psychotherapists to apply CBT as intended, managing patient beliefs about disease and treatment, and adapting psychotherapy to OCD subtypes. Finally, we then propose a literature-based definition of treatment-refractory OCD.

Empirical research in clinical supervision: a systematic review and suggestions for future studies.

BACKGROUND: Although clinical supervision is considered to be a major component of the development and maintenance of psychotherapeutic competencies, and despite an increase in supervision research, the empirical evidence on the topic remains sparse. METHODS: Because most previous reviews lack methodological rigor, we aimed to review the status and quality of the empirical literature on clinical supervision, and to provide suggestions for future research. MEDLINE, PsycInfo and the Web of Science Core Collection were searched and the review was conducted according to current guidelines. From the review results, we derived suggestions for future research on clinical supervision. RESULTS: The systematic literature search identified 19 publications from 15 empirical studies. Taking into account the review results, the following suggestions for further research emerged: Supervision research would benefit from proper descriptions of how studies are conducted according to current guidelines, more methodologically rigorous empirical studies, the investigation of active supervision interventions, from taking diverse outcome domains into account, and from investigating supervision from a meta-theoretical perspective. CONCLUSIONS: In all, the systematic review supported the notion that supervision research often lags behind psychotherapy research in general. Still, the results offer detailed starting points for further supervision research. TRIAL REGISTRATION: PROSPERO; CRD42017072606 , registered on June 20, 2017.

The assessment of cognitive-behavioral therapy skills in patients diagnosed with health anxiety: Development and pilot study on an observer-based rating scale.

Cognitive-behavioral therapy is a highly effective treatment of health anxiety, but it remains unclear through which mechanisms treatment effects prevail. Some evidence suggests that patients acquire skills-understood as techniques helping them reach therapy goals-through psychotherapy. In the current study, an observer-based rating scale for the skills assessment of patients with health anxiety (SAPH) was developed and validated in a pilot study. Based on 177 videotapes, four independent raters evaluated the frequency of skills acquired during cognitive and exposure therapy among 66 patients diagnosed with health anxiety with the SAPH. Predictive validity was evaluated by the Yale-Brown Obsessive-Compulsive Scale for Hypochondriasis. The SAPH demonstrated good interrater reliability (ICC(1,2)  = .88, p < .001, 95% CI [.81, .92]) and internal consistency (α = .94). Although patient skills did not significantly increase during three sessions, they significantly predicted a reduction in health anxiety symptoms at the end of treatment (R2  = .35). Patients' skills are highly important within the treatment of health anxiety. By providing external ratings of patients' skills with good psychometric properties, our pilot data suggest that the SAPH may complement current tools for the assessment of skills, specifically in targeting health anxiety.