Growth curves of common factors in psychotherapy: Multilevel growth modelling and outcome analysis.

OBJECTIVE: A large body of literature discusses change mechanisms underlying psychotherapy with an emphasis on common factors. The present study examined how different comprehensive common factors change over the course of therapy and whether this change was associated with clinical outcome at discharge. METHOD: Three hundred forty-eight adults (mean age = 32.1, SD = 10.6; 64% female) attended a standardized 14-week day-clinic psychotherapy program. They provided longitudinal data on common factors based on weekly assessments. Additionally, pre- and post-assessment questionnaires on clinical outcome were completed. Using multilevel modelling, we predicted common factors by time (week in therapy). Multiple linear regression models tested the association between changes in common factors and clinical outcome. RESULTS: The common factor 'Therapeutic Alliance' was best fitted by linear growth models, whereas models for the common factors 'Coping', 'Cognitive Integration' and 'Affective Processing' indicated logarithmic changes over time. 'Coping', that is change in patients' ability to cope with their individual problems, was most closely linked with outcome. CONCLUSIONS: The present study provides evidence for the changeability of common factors over the course of therapy as well as their specific contributions to psychotherapeutic progress.

Towards a taxonomy of common factors in psychotherapy-results of an expert survey.

BACKGROUND: How change comes about is hotly debated in psychotherapy research. One camp considers 'non-specific' or 'common factors', shared by different therapy approaches, as essential, whereas researchers of the other camp consider specific techniques as the essential ingredients of change. This controversy, however, suffers from unclear terminology and logical inconsistencies. The Taxonomy Project therefore aims at contributing to the definition and conceptualization of common factors of psychotherapy by analyzing their differential associations to standard techniques. METHODS: A review identified 22 common factors discussed in psychotherapy research literature. We conducted a survey, in which 68 psychotherapy experts assessed how common factors are implemented by specific techniques. Using hierarchical linear models, we predicted each common factor by techniques and by experts' age, gender and allegiance to a therapy orientation. RESULTS: Common factors differed largely in their relevance for technique implementation. Patient engagement, Affective experiencing and Therapeutic alliance were judged most relevant. Common factors also differed with respect to how well they could be explained by the set of techniques. We present detailed profiles of all common factors by the (positively or negatively) associated techniques. There were indications of a biased taxonomy not covering the embodiment of psychotherapy (expressed by body-centred techniques such as progressive muscle relaxation, biofeedback training and hypnosis). Likewise, common factors did not adequately represent effective psychodynamic and systemic techniques. CONCLUSION: This taxonomic endeavour is a step towards a clarification of important core constructs of psychotherapy. KEY PRACTITIONER MESSAGE: This article relates standard techniques of psychotherapy (well known to practising therapists) to the change factors/change mechanisms discussed in psychotherapy theory. It gives a short review of the current debate on the mechanisms by which psychotherapy works. We provide detailed profiles of change mechanisms and how they may be generated by practice techniques.

[Empirical Conceptualization of Common Factors in Psychotherapy: Factor Structure of the WEB]. / Allgemeine Wirkfaktoren der Psychotherapie empirisch konzeptualisieren: Die Faktorenstruktur des Wochenerfahrungsbogens (WEB).

OBJECTIVE: Our goal was to explore the association pattern of 26 common factors and thereby contribute conceptually to the debate on change mechanisms in psychotherapy with an empirically derived conception of superordinate common factors (global common factors). In addition, we tested reliability and validity aspects of a new instrument to assess common factors. METHOD: The activation of common factors during in- and outpatient psychotherapy was assessed in 502 patients using a weekly process measure ('Wochenerfahrungsbogen', WEB). The factor structure of the WEB was determined by exploratory factor analysis and verified by confirmatory factor analyses. RESULTS: The four factors Coping, Therapeutic Alliance, Cognitive Integration, and Affective Processing accounted for 59.8 % of the total variance. Subsequent confirmatory factor analyses, using in- and outpatient samples, confirmed this structure. CONCLUSIONS: The study provided an empirically based integrative categorisation of common factors. Results on reliability (internal consistency) and construct validity indicate that the WEB is an appropriate measurement instrument to investigate global common factors.

Patients' style of emotional processing moderates the impact of common factors in psychotherapy.

This study examined how patient characteristics concerning processing of emotions interact with common factors in psychotherapy. We focused on common factors of emotional processing in psychotherapy with regard to depression outcome. A total of 93 psychiatric outpatients were included. Patients completed preassessments and postassessments regarding depression symptoms and emotional processing style. In addition, the subjectively perceived activation of common factors related to emotional processing in therapy was assessed by the patients after each therapy session. Depending on patients' pretreatment characteristics in emotional processing, activation of the emotion-related common factor mindfulness in treatment had varying impact on depression outcome: The perceived activation of mindfulness had a positive impact on depression reduction only in patients with pretreatment deficits in cognitive representation and communication of emotions. In patients who did not show such deficits, the perceived activation of this common factor during treatment was negatively correlated with outcome. It appears that common factors in psychotherapy must match with patient characteristics to gain therapeutic significance. Examining the interplay of patient characteristics with common factors provides a promising approach to tailor psychotherapeutic procedures in the sense of a personalized psychotherapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

[Psycho-educational coping-oriented group therapy for schizophrenia patients]. / Psychoedukative und bewältigungsorientierte Gruppentherapie für SchizophreniepatientInnen.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a psycho-educational, coping-oriented therapy programme for patients with schizophrenia or schizo-affective disorder. METHOD: Controlled, prospective study design. In the experimental group the Therapy Manual for Psycho-education and Coping with Illness (PKB) was used, providing targeted information on the illness, medical treatment, prodromal symptoms, and health behaviour. Controls participated in supportive dialogues or in an occupational rehabilitation programme. Psychopathology, re-hospitalisations, knowledge, functional outcome and coping strategies were assessed before, directly after and 12 months post therapy. RESULTS: 82 patients participated. In both groups (experimental, control) a significant improvement in psychopathology and general functioning level were observed. Specific advantages for patients of the experimental group were limited to a few aspects, including rehospitalizations in the first year and certain coping strategies. CONCLUSION: In the treatment of schizophrenia different forms of psycho-social intervention (experimental, control) can be effective. Identification of subgroups profiting specially from certain types of intervention should be subject of future research.

Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses.

Over the past years, evidence for the efficacy of psychological therapies in schizophrenia has been summarized in a series of meta-analyses. The present contribution aims to provide a descriptive survey of the evidence for the efficacy of psychological therapies as derived from these meta-analyses and to supplement them by selected findings from an own recent meta-analysis. Relevant meta-analyses and randomized controlled trials were identified by searching several electronic databases and by hand searching of reference lists. In order to compare the findings of the existing meta-analyses, the reported effect sizes were extracted and transformed into a uniform effect size measure where possible. For the own meta-analysis, weighted mean effect size differences between comparison groups regarding various types of outcomes were estimated. Their significance was tested by confidence intervals, and heterogeneity tests were applied to examine the consistency of the effects. From the available meta-analyses, social skills training, cognitive remediation, psychoeducational coping-oriented interventions with families and relatives, as well as cognitive behavioral therapy of persistent positive symptoms emerge as effective adjuncts to pharmacotherapy. Social skills training consistently effectuates the acquisition of social skills, cognitive remediation leads to short-term improvements in cognitive functioning, family interventions decrease relapse and hospitalization rates, and cognitive behavioral therapy results in a reduction of positive symptoms. These benefits seem to be accompanied by slight improvements in social functioning. However, open questions remain as to the specific therapeutic ingredients, to the synergistic effects, to the indication, as well as to the generalizability of the findings to routine care.

The significance of coping as a therapeutic variable for the outcome of psychological therapy in schizophrenia.

Although there is now strong evidence confirming the efficacy of psychological therapies in schizophrenia, the therapeutic processes which they activate remain widely unknown. In order to effectively implement them in clinical practice, identification of these processes is essential. In a controlled study, the efficacy of a coping-oriented therapy approach for schizophrenia patients was tested. Furthermore, the study aimed at establishing preliminary hypotheses on the therapeutically relevant factors. Treatment effects were found in the prominence of psychopathology, the extent of cognizance of the disorder, and the level of social functioning. Moreover, a better psychopathological and social outcome as measured 12 and 18 months after completion of therapy was best predicted by the patients' mastery of active, problem-focused coping strategies immediately after completion of therapy. The findings underscore the clinical relevance of specific coping styles and corroborate the appropriateness of focusing on aspects of coping behavior in psychological interventions for schizophrenia patients.