An examination of therapists' professional characteristics as moderators of the effect of feedback on psychological treatment outcomes.

Feedback-informed treatment (FIT) has been shown to reduce the gap between more and less effective therapists. This study aimed to examine therapists' professional characteristics as potential moderators of the effect of feedback on treatment outcomes.The IAPT-FIT Trial was a clinical trial where therapists were randomly assigned to a FIT group or a usual care control group. Treatment response was monitored using measures of depression (PHQ-9), anxiety (GAD-7) and functional impairment (WSAS). In a secondary analysis of this trial (n = 1,835 patients; t = 67 therapists), we used multilevel modelling to examine interactions between therapists' professional characteristics (e.g., attitude towards and self-efficacy regarding feedback utilization, decision-making style, job satisfaction, burnout, difficulties in practice, coping styles, caseload size) with random allocation (FIT vs. controls) to identify moderators of the effects of feedback.Between 9.6% and 10.8% of variability in treatment outcomes was attributable to therapist effects. Therapist-level caseload sizes and external feedback propensity (EFP) moderated the effect of feedback on depression outcomes. No statistically significant main effects were found for any of the included therapist characteristics.FIT reduced variability in outcomes between therapists and was particularly effective for therapists with high EFP and larger caseloads.

Predicting Scaling Properties from a Single Fluid Configuration.

Time-dependent dynamical properties of a fluid cannot be estimated directly from a single configuration without performing a simulation. Here, however, we present a method that predicts the scaling properties of both structure and dynamics from a single configuration. The method is demonstrated to work well for the Lennard-Jones fluid as well as the viscous Kob-Andersen Lennard-Jones mixture, both in and out of equilibrium. The method is conceptually simple and easy to implement and, thus, should become a standard tool in the study of scaling properties of fluids and liquids.

Therapist-led interventions for the treatment of traumatic stress symptoms in cancer survivors: A systematic literature review.

OBJECTIVE: We reviewed the evidence regarding the effectiveness of therapist-led interventions for reducing symptoms of traumatic stress in cancer survivors. METHODS: This systematic review was completed in accordance with the guidelines illustrated by Popay and colleagues and the following online databases, PsychInfo, Medline, CINAHL, were searched for peer-reviewed literature. Further studies were searched through Google Scholar and manually scanning the reference lists of all included studies. The PRISMA guidelines were followed to report results. RESULTS: Sixteen studies were identified, their quality varied and the interventions broadly fell into two categories: CBT-based and non-CBT interventions. Effect sizes were small to moderate in 12 studies and large in four. Drop-out rates were mostly low. CONCLUSION: This review has demonstrated that the research in this field is still scarce and due to the data mostly suggesting a small to moderate effect, firm conclusions cannot be drawn on the effectiveness of the included interventions.

The predictive value of patient, therapist, and in-session ratings of motivational factors early in remote cognitive behavioural therapy for severe health anxiety.

OBJECTIVES: Remote psychotherapy and the prevalence of Severe Health Anxiety (SHA) are both growing as a result of the COVID-19 pandemic. Remotely delivered Cognitive Behavioural Therapy (rCBT) for SHA is evidenced as effective, but many who seek help do not benefit. Motivational processes can influence outcomes, but it is unclear what assessment methods offer the best clinical utility in rCBT for SHA. DESIGN: This study compared the predictive validity of patient, therapist and in-session ratings of motivational factors taken at session two of rCBT for SHA among high healthcare users experiencing multimorbidity. METHODS: Motivational factors were assessed for 56 participants who attended at least two sessions of CBT for SHA delivered via video-conferencing or telephone. Following session two, therapists and patients completed online assessments of patient motivation. Two trained observers also rated motivational factors and therapeutic alliance from in-session interactions using session two recordings and transcripts. Multilevel modelling was used to predict health anxiety and a range of secondary health outcomes from motivation assessments. RESULTS: Where patients were more actively engaged in discussion of positive changes during session two, greater outcome improvements ensued in health anxiety and all secondary outcomes. Conversely, larger proportions of session two spent describing problems predicted poorer outcomes. Therapist and patient assessments of motivation did not predict health anxiety, but therapist assessments of client confidence and motivation predicted all secondary outcomes. CONCLUSIONS: Motivation remains an important process in CBT when delivered remotely, and motivational factors may predict outcomes more consistently from in-session interactions, compared to self-reports.

Does mesoscopic elasticity control viscous slowing down in glassforming liquids?

The dramatic slowing down of relaxation dynamics of liquids approaching the glass transition remains a highly debated problem, where the crux of the puzzle resides in the elusive increase in the activation barrier ΔE(T) with decreasing temperature T. A class of theoretical frameworks-known as elastic models-attribute this temperature dependence to the variations of the liquid's macroscopic elasticity, quantified by the high-frequency shear modulus G∞(T). While elastic models find some support in a number of experimental studies, these models do not take into account the spatial structures, length scales, and heterogeneity associated with structural relaxation in supercooled liquids. Here, we propose and test the possibility that viscous slowing down is controlled by a mesoscopic elastic stiffness κ(T), defined as the characteristic stiffness of response fields to local dipole forces in the liquid's underlying inherent structures. First, we show that κ(T)-which is intimately related to the energy and length scales characterizing quasilocalized, nonphononic excitations in glasses-increases more strongly with decreasing T than the macroscopic inherent structure shear modulus G(T) [the glass counterpart of liquids' G∞(T)] in several computer liquids. Second, we show that the simple relation ΔE(T) ∝ κ(T) holds remarkably well for some computer liquids, suggesting a direct connection between the liquid's underlying mesoscopic elasticity and enthalpic energy barriers. On the other hand, we show that for other computer liquids, the above relation fails. Finally, we provide strong evidence that what distinguishes computer liquids in which the ΔE(T) ∝ κ(T) relation holds from those in which it does not is that the latter feature highly fragmented/granular potential energy landscapes, where many sub-basins separated by low activation barriers exist. Under such conditions, it appears that the sub-basins do not properly represent the landscape properties relevant for structural relaxation.

Isomorph Invariance of Higher-Order Structural Measures in Four Lennard-Jones Systems.

In the condensed liquid phase, both single- and multicomponent Lennard-Jones (LJ) systems obey the "hidden-scale-invariance" symmetry to a good approximation. Defining an isomorph as a line of constant excess entropy in the thermodynamic phase diagram, the consequent approximate isomorph invariance of structure and dynamics in appropriate units is well documented. However, although all measures of the structure are predicted to be isomorph invariant, with few exceptions only the radial distribution function (RDF) has been investigated. This paper studies the variation along isomorphs of the nearest-neighbor geometry quantified by the occurrence of Voronoi structures, Frank-Kasper bonds, icosahedral local order, and bond-orientational order. Data are presented for the standard LJ system and for three binary LJ mixtures (Kob-Andersen, Wahnström, NiY2). We find that, while the nearest-neighbor geometry generally varies significantly throughout the phase diagram, good invariance is observed along the isomorphs. We conclude that higher-order structural correlations are no less isomorph invariant than is the RDF.

Predicting outcomes and sudden gains from initial in-session interactions during remote cognitive-behavioural therapy for severe health anxiety.

There has been a dramatic increase in remote psychotherapy since the onset of the COVID-19 crisis. There is also expected to be an increase in mental health problems in the wake of the COVID-19 pandemic. An increase in severe health anxiety (SHA) is particularly anticipated, for which cognitive-behavioural therapy (CBT) is a frontline treatment. However, it is unclear what interaction types are associated with outcome-improvement in remote-CBT (rCBT) for SHA. This study aimed to identify interaction types that predict outcomes and sudden gains in rCBT for SHA using initial therapy session content. Forty-eight participants in rCBT for SHA had interactions at their first sessions categorized and rated in terms of patient activation: an individual's confidence and ability to manage their health. Multilevel modelling assessed whether early interaction types predicted session-by-session wellbeing. For participants experiencing sudden gains (n = 12) interactions at the session directly prior to the gain were similarly categorized and rated. The scores were then compared with ratings for the preceding session. A smaller proportion of early sessions was taken up with problem descriptions among those with greater outcome improvements. There was also a significant reduction in the proportion of the session spent describing problems in the session directly prior to a sudden gain, as compared with the previous session. Conversely, clients with better outcomes made more positive evaluations of themselves and therapy, noticed more positive changes and made more contributions to structuring interactions at initial sessions. Specific early interaction types predict session-by-session outcomes and precede sudden gains in rCBT for SHA.

Solid-like mean-square displacement in glass-forming liquids.

It was recently shown that the real part of the frequency-dependent fluidity for several glass-forming liquids of different chemistry conforms to the prediction of the random barrier model (RBM) devised for ac electrical conduction in disordered solids [Bierwirth et al., Phys. Rev. Lett. 119, 248001 (2017)]. Inspired by these results, we introduce a crystallization-resistant modification of the Kob-Andersen binary Lennard-Jones mixture for which the results of extensive graphics-processing-unit-based molecular-dynamics simulations are presented. We find that the low-temperature mean-square displacement is fitted well by the RBM prediction, which involves no shape parameters. This finding highlights the challenge of explaining why a simple model based on hopping of non-interacting particles in a fixed random energy landscape with identical minima can reproduce the complex and highly cooperative dynamics of glass-forming liquids.

The EXP pair-potential system. IV. Isotherms, isochores, and isomorphs in the two crystalline phases.

This paper studies numerically the solid phase of a system of particles interacting by the exponentially repulsive pair potential, which is a face-centered cubic (fcc) crystal at low densities and a body-centered cubic (bcc) crystal at higher densities [U. R. Pedersen et al., J. Chem. Phys. 150, 174501 (2019)]. Structure is studied via the pair-distribution function and dynamics via the velocity autocorrelation function and the phonon density of states. These quantities are evaluated along isotherms, isochores, and three isomorphs in both crystal phases. Isomorphs are traced out by integrating the density-temperature relation characterizing configurational adiabats, starting from state points in the middle of the fcc-bcc coexistence region. Good isomorph invariance of structure and dynamics is seen in both crystal phases, which is notable in view of the large density variations studied. This is consistent with the fact that the virial potential-energy correlation coefficient is close to unity in the entire fcc phase and in most of the bcc phase (basically below the re-entrant density). Our findings confirm that the isomorph theory, developed and primarily studied for liquids, applies equally well for solids.

Patient activation in psychotherapy interactions: Developing and validating the consultation interactions coding scheme.

OBJECTIVE: We describe the development of an instrument aiming to offer interaction-level feedback based on "patient activation": client confidence and perceived ability to manage their health. METHOD: Twenty-two session-transcripts from cognitive behavioral therapy with high-users of healthcare were analyzed thematically, producing themes describing in-session interactions. Themes were subcategorized using patient activation theory into high and low activation presentations. Two coders new to the process were trained to use this consultation interactions coding scheme (CICS). Inter-rater reliability (IRR), convergent validity, and clinical utility were assessed and illustrated with extreme cases. RESULTS: Good-to-excellent IRR was achieved. The CICS, therapeutic alliance, and therapist competence were correlated. Client engagement in session-structuring interactions correlated with outcome. The highest CICS scorer showed multiple outcome-improvements, the lowest scorer reported deteriorations. CONCLUSIONS: This study presents the CICS's psychometric properties and indicates the value of client engagement in session-structuring.

Extending the use of routine outcome monitoring: Predicting long-term outcomes in cognitive behavioral therapy for severe health anxiety.

Objective: Routine outcome monitoring (ROM) is a well-evidenced means of improving psychotherapy's effectiveness. However, it is unclear how meaningful ROM is for problems that span physical and mental health, such as severe health anxiety. Physical and mental health comorbidities are common amongst severe health anxiety sufferers and cognitive behavioral therapy (CBT) is a recommended treatment. Method: Seventy-nine participants received CBT for severe health anxiety in a clinical trial. The Outcome Rating Scale (ORS: a ROM assessment of wellbeing) was completed at each session. Multilevel modeling assessed whether last-session ORS predicted health anxiety and other outcomes over 12-month follow-up. Similar models were developed using health anxiety as a comparative outcome-predictor. Outcome-improvements of treatment-responders with sudden gains were compared to those of non-sudden-gainers. Results: Last-session ORS scores predicted all outcomes up to 12 months later, with a comparable predictive effect to health anxiety. Sudden-gainers on the ORS reported significantly greater improvement in depression, functioning, and wellbeing, but no difference in health anxiety or other measures. Conclusion: The ORS may be a feasible, overall estimate of health, functioning, and quality of life in psychotherapy for severe health anxiety. Sudden gains on the ORS may be clinically meaningful with respect to some long-term outcomes.

Tyrosine kinase inhibitors relax pulmonary arteries in human and murine precision-cut lung slices.

BACKGROUND: Tyrosine kinase inhibitors (TKIs) inhibit the platelet derived growth factor receptor (PDGFR) and gain increasing significance in the therapy of proliferative diseases, e.g. pulmonary arterial hypertension (PAH). Moreover, TKIs relax pulmonary vessels of rats and guinea pigs. So far, it is unknown, whether TKIs exert relaxation in human and murine pulmonary vessels. Thus, we studied the effects of TKIs and the PDGFR-agonist PDGF-BB in precision-cut lung slices (PCLS) from both species. METHODS: The vascular effects of imatinib (mice/human) or nilotinib (human) were studied in Endothelin-1 (ET-1) pre-constricted pulmonary arteries (PAs) or veins (PVs) by videomicroscopy. Baseline initial vessel area (IVA) was defined as 100%. With regard to TKI-induced relaxation, K+-channel activation was studied in human PAs (PCLS) and imatinib/nilotinib-related changes of cAMP and cGMP were analysed in human PAs/PVs (ELISA). Finally, the contractile potency of PDGF-BB was explored in PCLS (mice/human). RESULTS: Murine PCLS: Imatinib (10 µM) relaxed ET-1-pre-constricted PAs to 167% of IVA. Vice versa, 100 nM PDGF-BB contracted PAs to 60% of IVA and pre-treatment with imatinib or amlodipine prevented PDGF-BB-induced contraction. Murine PVs reacted only slightly to imatinib or PDGF-BB. Human PCLS: 100 µM imatinib or nilotinib relaxed ET-1-pre-constricted PAs to 166% or 145% of IVA, respectively, due to the activation of KATP-, BKCa2+- or Kv-channels. In PVs, imatinib exerted only slight relaxation and nilotinib had no effect. Imatinib and nilotinib increased cAMP in human PAs, but not in PVs. In addition, PDGF-BB contracted human PAs/PVs, which was prevented by imatinib. CONCLUSIONS: TKIs relax pre-constricted PAs/PVs from both, mice and humans. In human PAs, the activation of K+-channels and the generation of cAMP are relevant for TKI-induced relaxation. Vice versa, PDGF-BB contracts PAs/PVs (human/mice) due to PDGFR. In murine PAs, PDGF-BB-induced contraction depends on intracellular calcium. So, PDGFR regulates the tone of PAs/PVs. Since TKIs combine relaxant and antiproliferative effects, they may be promising in therapy of PAH.

Revisiting the Stokes-Einstein relation without a hydrodynamic diameter.

We present diffusion coefficient and shear viscosity data for the Lennard-Jones fluid along nine isochores above the critical density, each involving a temperature variation of roughly two orders of magnitude. The data are analyzed with respect to the Stokes-Einstein (SE) relation, which breaks down gradually at high temperatures. This is rationalized in terms of the fact that the reduced diffusion coefficient D ̃ and the reduced viscosity η ̃ are both constant along the system's lines of constant excess entropy (the isomorphs). As a consequence, D ̃ η ̃ is a function of T/T Ref(ρ) in which T is the temperature, ρ is the density, and T Ref(ρ) is the temperature as a function of the density along a reference isomorph. This allows one to successfully predict the viscosity from the diffusion coefficient in the studied region of the thermodynamic phase diagram.

The EXP pair-potential system. III. Thermodynamic phase diagram.

This paper determines the thermodynamic phase diagram of the EXP system of particles interacting by the purely repulsive exponential pair potential. The solid phase is face-centered cubic (fcc) at low densities and pressures. At higher densities and pressures, the solid phase is body-centered cubic (bcc) with a re-entrant liquid phase at the highest pressures simulated. The investigation first identifies the phase diagram at zero temperature at which the following four crystal structures are considered: fcc, bcc, hexagonal close packed, and cubic diamond. There is a T = 0 phase transition at pressure 2.651 × 10-3 with the thermodynamically stable structure being fcc below and bcc above this pressure. The densities of the two crystal structures at the phase transition are 1.7469 × 10-2 (fcc) and 1.7471 × 10-2 (bcc). At finite temperatures, the fcc-bcc, fcc-liquid, and bcc-liquid coexistence lines are determined by numerical integration of the Clausius-Clapeyron equation and validated by interface-pinning simulations at selected state points. The bcc-fcc phase transition is a weak first-order transition. The liquid-fcc-bcc triple point, which is determined by the interface-pinning method, has temperature 5.9 × 10-5 and pressure 2.5 × 10-6; the triple-point densities are 1.556 × 10-3 (liquid), 1.583 × 10-3 (bcc), and 1.587 × 10-3 (fcc).

Phase Diagram of Kob-Andersen-Type Binary Lennard-Jones Mixtures.

The binary Kob-Andersen (KA) Lennard-Jones mixture is the standard model for computational studies of viscous liquids and the glass transition. For very long simulations, the viscous KA system crystallizes, however, by phase separating into a pure A particle phase forming a fcc crystal. We present the thermodynamic phase diagram for KA-type mixtures consisting of up to 50% small (B) particles showing, in particular, that the melting temperature of the standard KA system at liquid density 1.2 is 1.028(3) in A particle Lennard-Jones units. At large B particle concentrations, the system crystallizes into the CsCl crystal structure. The eutectic corresponding to the fcc and CsCl structures is cutoff in a narrow interval of B particle concentrations around 26% at which the bipyramidal orthorhombic PuBr_{3} structure is the thermodynamically stable phase. The melting temperature's variation with B particle concentration at two constant pressures, as well as at the constant density 1.2, is estimated from simulations at pressure 10.19 using isomorph theory. Our data demonstrate approximate identity between the melting temperature and the onset temperature below which viscous dynamics appears. Finally, the nature of the solid-liquid interface is briefly discussed.

The EXP pair-potential system. II. Fluid phase isomorphs.

This paper continues the investigation of the exponentially repulsive EXP pair-potential system of Paper I [A. K. Bacher et al., J. Chem. Phys. 149, 114501 (2018)] with a focus on isomorphs in the low-temperature gas and liquid phases. As expected from the EXP system's strong virial potential-energy correlations, the reduced-unit structure and dynamics are isomorph invariant to a good approximation. Three methods for generating isomorphs are compared: the small-step method that is exact in the limit of small density changes and two versions of the direct-isomorph-check method that allows for much larger density changes. Results from the latter two approximate methods are compared to those of the small-step method for each of the three isomorphs generated by 230 one percent density changes, covering one decade of density variation. Both approximate methods work well.

The EXP pair-potential system. I. Fluid phase isotherms, isochores, and quasiuniversality.

It was recently shown that the exponentially repulsive EXP pair potential defines a system of particles in terms of which simple liquids' quasiuniversality may be explained [A. K. Bacher et al., Nat. Commun. 5, 5424 (2014); J. C. Dyre, J. Phys.: Condens. Matter 28, 323001 (2016)]. This paper and its companion [A. K. Bacher et al., J. Chem. Phys. 149, 114502 (2018)] present a detailed simulation study of the EXP system. Here we study how structure monitored by the radial distribution function and dynamics monitored by the mean-square displacement as a function of time evolve along the system's isotherms and isochores. The focus is on the gas and liquid phases, which are distinguished pragmatically by the absence or presence of a minimum in the radial distribution function above its first maximum. A constant-potential-energy (NVU)-based proof of quasiuniversality is presented, and quasiuniversality is illustrated by showing that the structure of the Lennard-Jones system at four state points is well approximated by those of EXP pair-potential systems with the same reduced diffusion constant. Paper II studies the EXP system's isomorphs, focusing also on the gas and liquid phases.

Communication: Simple liquids' high-density viscosity.

This paper argues that the viscosity of simple fluids at densities above that of the triple point is a specific function of temperature relative to the freezing temperature at the density in question. The proposed viscosity expression, which is arrived at in part by reference to the isomorph theory of systems with hidden scale invariance, describes computer simulations of the Lennard-Jones system as well as argon and methane experimental data and simulation results for an effective-pair-potential model of liquid sodium.

A Systematic Review of the Effect of Therapists' Internalized Models of Relationships on the Quality of the Therapeutic Relationship.

OBJECTIVE: Previous reviews have found equivocal evidence of an association between therapists' internalized relational models and the therapeutic relationship and have neglected empirical literature based on Sullivan's notion of introject. This review expanded upon previous reviews to examine the effect of therapist internalized relational models on a broader conceptualization of the therapeutic relationship. METHOD: Systematic search processes identified 22 papers measuring therapist attachment and/or introject and therapeutic relationship: 19 on therapist attachment, 5 on introject with 2 overlapping. RESULTS: Overall, despite heterogeneity in design and variable methodological quality, evidence suggests that therapist attachment affects therapeutic relationship quality, observed in client-rated evaluation, therapist negative countertransference, empathy, and problems in therapy. Interaction effects between client and therapist attachment style were also found. Evidence suggesting that therapist introject also affects therapeutic relationship quality, including therapists' manner and feelings toward their clients, was stronger. CONCLUSION: Evidence clearly shows that therapists' internalized relational models affect the therapeutic relationship. More research is necessary to clarify exactly how therapist and client internalized relational models interact and translate these findings into clinical practice.

'Do You Practice What You Preach?' A Qualitative Exploration of Therapists' Personal Practice of Compassion Focused Therapy.

BACKGROUND: Therapists' personal practice of therapy techniques can impact on a range of areas, including: empathy for the client, therapeutic understanding, therapist skills and self-awareness. Compassion Focused Therapy (CFT) draws extensively on personal practice during training, and on-going personal practice is encouraged. However, the impact of this has not been examined. OBJECTIVES: To explore therapists' experiences of personal practice in relation to CFT, and the impact this has upon them and their therapeutic work. DESIGN: A qualitative approach was adopted, using inductive thematic analysis. METHODS: Ten therapists, who had trained in CFT, took part in a semi-structured interview to explore their experiences of personal practice. RESULTS: Five main themes were identified. These highlighted that: (1) experiences of personal practice often felt strange to start with but were surprisingly powerful; (2) with practice, the exercises became more automatic and could be adopted as a 'way of life'; (3) personal practice was felt to increase both self-compassion and compassion for others; (4) personal practice often helped participants to feel more present for their clients; and (5) participants were more aware of what they were bringing to therapy. CONCLUSIONS: This exploratory study demonstrated that personal practice is an important part of CFT training and can have a positive impact upon therapists both personally and professionally. It is concluded that the results justify further research in order to establish the applicability of these findings with a larger sample. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGES: Personal practice facilitates experiential learning and is an important element of CFT training, which impacts on both personal and professional development. CFT trainers need to ensure that sufficient time is provided for both personal practice and reflection. CFT trainees should be aware that initial reactions to personal practice can be powerful and sometimes unsettling. As for therapy itself, working through fears, blocks and resistances is important. Personal practice is a valuable self-care strategy, and therapists are encouraged to engage in personal practice after training.