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Preview: Journal of Consulting and Clinical Psychology - Vol 77, Iss 6

Journal of Consulting and Clinical Psychology - Vol 86, Iss 4



The Journal of Consulting and Clinical Psychology publishes original contributions on the following topics: (a) the development, validity, and use of techniques of diagnosis, treatment, and prevention of disordered behavior; (b) studies of populations of



Last Build Date: Sun, 22 Apr 2018 04:00:23 GMT

 



Mental health care consumers’ relative valuing of clinician performance information.

Thu, 08 Mar 2018 05:00:00 GMT

Background: Research demonstrates significant variability in mental health clinicians’ overall and domain-specific effectiveness with their patients. Despite calls to increase patient access to performance information, little is known about patients’ relative valuing of this information in the context of other treatment factors. Objective: We aimed to obtain an understanding of patients’ relative valuing of provider performance track records and other therapist and treatment characteristics for their mental health care decision making. Method: Participants were 403 (Mage = 41.20; 66.5% female) community mental health patients who completed a multicomponent survey that included an adapted delayed-discounting paradigm to examine the relative valuing. Multiple descriptive, quantitative indices of relative valuing were calculated, as well as an exploratory latent profile analysis to ascertain the presence of homogenous relative-valuing subgroups. Results: Overall, participants valued provider track record information. They also evidenced relatively higher preference values for working with therapists who had specific efficacy in treating their primary problem domain, charged less, and with whom there is a high likelihood of establishing a good alliance. Two latent profiles were identified: one representing higher valuing of provider performance and another consistently representing less emphasis. Participants with higher track-record valuing were younger, believed that therapists are not interchangeable, and endorsed trust in the collection and use of performance information. Conclusion: Harnessing clinician information to make more personalized and informed treatment decisions could potentially promote better treatment engagement, retention, and outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



Individualized motivational plans in batterer intervention programs: A randomized clinical trial.

Thu, 12 Apr 2018 04:00:00 GMT

Objective: Treatment compliance and motivation to change are among the main challenges to improving batterer intervention program (BIP) effectiveness. This study examined whether adding an individualized motivational plan (IMP) to a standard BIP (SBIP) increased intervention effectiveness relative to BIP alone. Method: One hundred sixty males convicted of intimate partner violence were randomly assigned to receive 70 hr of either SBIP or SBIP plus IMP. The IMP is based on motivational interviewing, stages of change, and strength-based theory principles. We collected the data at baseline, at the end of the 9-month program and at 6-month follow-up. Final outcome was recidivism (recidivism data obtained from official databases, self-reported recidivism, and therapists’ assessment of recidivism risk), and proximal outcomes included treatment compliance (dropout and intervention dose), and stage of change. We analyzed the results using both intent-to-treat (ITT) and per-protocol (PP) approaches. Results: Findings indicated that the SBIP plus IMP participants received significantly more intervention dose (R² = .08), finished the intervention in a more advanced stage of change (ITT, R² = .17; PP, R² = .22), reported less physical violence after treatment (ITT, odds ratio = .63; PP, odds ratio = .34), and had a higher reduction in recidivism risk (ITT, R² = .64; PP, R² = .56) than SBIP participants. Conclusions: These results highlight the relevance of alternative approaches, including strategies to increase treatment compliance and motivation for change, in BIPs. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



A mediation analysis of treatment processes in the UK Alcohol Treatment Trial.

Mon, 05 Mar 2018 05:00:00 GMT

Objective: To determine whether treatment outcomes are mediated by therapist behaviors consistent with the theoretical postulates on which two contrasting treatments are based. Method: We used data from the U.K. Alcohol Treatment Trial (UKATT), a pragmatic, multicenter, randomized controlled trial comparing the effectiveness of Motivational Enhancement Therapy (MET) and Social Behavior and Network Therapy (SBNT) in the treatment of alcohol problems. N = 376 clients (mean age 42.5, 74.5% male) had 12-month follow-up data and one treatment session recorded and coded using the UKATT Process Rating Scale, a reliable manual-based assessment of treatment fidelity including frequency and quality ratings of treatment-specific therapist tasks and therapist styles. Analyses were conducted using a mediation framework. Results: Analysis of individual paths from treatment condition to treatment process indices (a path) and from treatment process indices to alcohol outcomes (b path) showed that (a) SBNT therapists more often used SBNT-specific behaviors, and did so with overall higher quality; (b) MET therapists more often used MET-specific behaviors, but there was no evidence that they performed these behaviors with higher quality than SBNT therapists; (c) only the quality of MET behaviors significantly predicted 12-month alcohol outcomes, irrespective of treatment condition. Consistently, there were no significant indirect effects. Multiple component analysis indicated that therapist quality of specific tasks influenced outcomes. Conclusions: The quality of delivery of the same treatment tasks in both treatments studied transcended the impact of delivering treatments according to different theoretical underpinnings in UKATT. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



Potential mechanisms involved in the effect of cognitive behavioral therapy on fatigue severity in Type 1 diabetes.

Thu, 12 Apr 2018 04:00:00 GMT

Objective: To identify mediators of the beneficial effect of cognitive–behavioral therapy (CBT) on fatigue severity in chronically fatigued patients with Type 1 diabetes. Method: We performed secondary analyses of a randomized controlled trial testing the efficacy of CBT. Primary outcome was fatigue severity assessed with the Checklist Individual Strength, subscale fatigue severity. We used multiple mediation analysis to determine potential mediators of the treatment effect. Proposed mediators were symptom focusing, self-efficacy concerning fatigue and pain, perceived activity, sleep disturbances, confidence in diabetes self-care, diabetes distress and discrepancy regarding social support. Actigraphy was used to assess the level of physical activity. The analysis was repeated with depressive symptoms as potential mediator to test whether this caused a change in the other fatigue-related mediators. Results: The effect of CBT on fatigue severity was partly mediated by a change in symptom focusing (−1.39, 95% CI [−3.32, −0.19]), fear avoidance (−1.10, 95% CI [−2.49, −0.22]), self-efficacy concerning fatigue (−1.95, 95% CI [−4.51, −0.40]), and perceived physical activity (−2.44, 95% CI [−4.53, −1.07]). Depressive symptoms were also a mediator (−1.22, 95% CI [−2.56, −0.38]), but the aforementioned fatigue-perpetuating factors still explained part of the treatment effect. Conclusions: Changes in cognitions about fatigue and activity, and a change in depressive symptoms partly mediated the treatment effect of CBT on fatigue severity in Type 1 diabetes. The mediators found are similar to those explaining the effects of CBT in other chronic diseases. This provides knowledge for the development of more effective and efficient interventions for fatigue. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



Congruence of therapeutic bond perceptions and its relation to treatment outcome: Within- and between-dyad effects.

Thu, 01 Feb 2018 05:00:00 GMT

Objective: The present study investigates the association between congruence of patients’ and therapists’ perceptions of the therapeutic bond and symptom improvement. Method: Bond congruence-outcome associations were examined on the within- and between-dyad level for 580 patients (mainly depression and anxiety) receiving cognitive–behavioral therapy. Symptom change was assessed on a session-to-session level as well as from pre- to posttreatment. For the between-dyad analyses, the truth and bias model was applied. For the within-dyad analyses, polynomial regression and response surface analysis were conducted. Results: On the between-dyad level, higher temporal congruence between patients’ and therapists’ bond ratings (i.e., their correlation) was associated with better treatment outcomes. Additionally, the average discrepancy between therapists’ and patients’ bond ratings showed a significant quadratic association with treatment outcome. A tendency for therapists to moderately rate the bond lower than their patients’ showed lowest posttreatment symptom scores. On the within-dyad level, we found that when patients’ and therapists’ ratings were in “agreement,” higher bond scores were associated with fewer next-session symptoms. For “disagreement,” the results showed that if therapists rated the bond as weak, whereas their patients rated it as strong, higher subsequent symptom distress was observed than if patients rated the bond as weak and their therapists rated it as strong. Conclusions: The present study highlights the importance of therapists being vigilant to session-to-session changes in the therapeutic bond to adjust their interventions accordingly. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



Session-to-session effects of alliance ruptures in outpatient CBT: Within- and between-patient associations.

Thu, 12 Apr 2018 04:00:00 GMT

Objective: The concept of alliance ruptures has had a large impact on contemporary studies of the alliance. Although this debate mainly focuses on the effect of ruptures and repairs on subsequent alliance and outcome levels within patients, to date no study has actually examined these within-patient effects. The present study fills this lacuna by examining the effect of alliance ruptures and in-session repairs on alliance ratings and symptom impairment in the subsequent session, accounting for the temporal sequence of ruptures and symptom impairment. Method: Ruptures and in-session repairs were rated by 1,210 patients and 147 therapists using a postsession questionnaire (PSQ-P/-T). Alliance was assessed with the Bern postsession reports and symptomatic impairment with the Hopkins symptom checklist, short form. Results: Patient- and therapist-reported ruptures were significant predictors of subsequent alliance and symptom impairment. While sessions in which both patient and therapist perceived a rupture were especially detrimental for next session symptom distress, they were less damaging to next session alliance levels than sessions in which either only the patient or the therapist experienced the rupture. Neither the intensity of the rupture nor the perceived level of in-session repair were associated with next-session fluctuations in symptom or alliance levels within-patient. Conclusion: The findings demonstrate the importance of disentangling between- and within-patient rupture and in-session repair processes to better understand the roles of rupture and repair in treatment. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



Treatment expectancy and working alliance in pharmacotherapy as predictors of outcomes in complicated grief.

Thu, 12 Apr 2018 04:00:00 GMT

Objective: Nonspecific factors, such as treatment outcome expectancy and working alliance, can influence treatment outcome. No studies to date have examined the role of expectancy and alliance on pharmacotherapy outcomes in individuals with complicated grief (CG). Method: This secondary analysis of a larger randomized, control trial (RCT) examined the relationship between pharmacotherapy expectancy and alliance on treatment outcome in adults with CG who were participating in a multisite, double-blind, RCT examining the efficacy of citalopram and complicated grief treatment (CGT). Participants (n = 202) were randomized to one of four treatment conditions: citalopram (CIT), placebo (PBO), CGT + citalopram (CGT + CIT), or CGT + placebo (CGT + PBO). Results: Pharmacotherapy outcome expectancy and working alliance were higher among individuals randomized to CGT + CIT and CGT + PBO compared with CIT or PBO without CGT. Pharmacotherapy outcome expectancy was higher at Week 2 among individuals who ultimately responded to treatment compared with those who did not and among those who remained in treatment compared with those who dropped out. In contrast, working alliance did not correlate with dropout or treatment outcomes in pharmacotherapy. Conclusions: Expectancy for medication was higher among individuals randomized to receive CGT. Clinicians should assess symptoms and expectancies in the first weeks of treatment because these could be early markers of drop out and treatment response. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



Associations of patient-rated emotional bond and vocally encoded emotional arousal among clinicians and acutely suicidal military personnel.

Thu, 12 Apr 2018 04:00:00 GMT

Objective: To determine if synchrony in emotional arousal and affective regulation between patients and clinicians reflect emotional bonding during emergency behavioral health appointments. Method: Audio recordings of suicide risk assessment interviews and crisis intervention planning with 54 suicidal active duty soldiers presenting to an emergency department or behavioral health clinic were analyzed. Emotional arousal was assessed using mean fundamental frequency. Patient-rated emotional bond was assessed with the Working Alliance Inventory, Short Form (Hatcher & Gillaspy, 2014). Actor-partner interdependence modeling was used to identify moment-to-moment patterns of covariance among clinician and patient emotional arousal. Results: Greater synchrony in clinician and patient emotional arousal was positively associated with higher emotional bond ratings during the crisis intervention but not the risk assessment interview. During the risk assessment interview, higher emotional bond was associated with a dysregulating effect of the clinician on the patient’s emotional arousal (i.e., larger fluctuations in the patient’s emotional arousal). The reverse pattern was seen during the intervention: Higher emotional bond was associated with a regulating effect of the clinician on the patient’s emotional arousal (i.e., smaller fluctuations in the patient’s emotional arousal). Emotional bond during the intervention was also positively associated with a regulating effect of the patient on the clinician’s emotional arousal. Conclusion: Emotional bonding during emergency clinical encounters is associated with patient–clinician synchrony in emotional states. During crisis interventions, emotional bonding is also associated with mutual down-regulation of emotional arousal among patients and clinicians. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



The effect of alliance-focused training on a cognitive-behavioral therapy for personality disorders.

Thu, 12 Apr 2018 04:00:00 GMT

Objective: To improve success rates in psychotherapy, we developed and evaluated an alliance-focused training (AFT) protocol with regard to patient–therapist interpersonal behavior in a 30-session protocol of cognitive-behavioral therapy (CBT) for outpatients comorbid with Axis I and II conditions. Method: Participants included 40 patients treated by 40 therapists in a multiple baseline design in which novice therapists trained to fidelity standards in CBT were introduced to AFT at different time intervals (after either 8 or 16 sessions) during a 30-session CBT protocol. Interpersonal behaviors were assessed with a simplified version of the Structural Analysis of Social Behavior (SASB) on videotaped sessions sampled from the early (between Sessions 6 through 8), mid (Sessions 14 through 16), and late (Sessions 22 through 24) phases of therapy. Results: As predicted, several significant interactions were observed between within-subject interpersonal change and between-groups differences in exposure to AFT. Specifically, there were decreases in patient dependence and in therapist control (including criticism), plus increases in patient expressiveness and in therapist affirmation and expressiveness, all of which could be attributed to AFT. The predictive relationship of several of these variables to session-level and overall treatment outcome was also demonstrated. Conclusions: This study demonstrates that novice CBT therapists can be trained to improve their interpersonal process with patients who present with comorbid diagnoses, including a personality disorder. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



When therapist estimations of the process of treatment can predict patients rating on outcome: The case of the working alliance.

Thu, 12 Apr 2018 04:00:00 GMT

Objective: It has been demonstrated that patient perspective on alliance can predict subsequent treatment outcome as reported by the therapist but not the other way around. This study aimed to investigate the circumstances in which therapists can provide estimations of alliance capable of predicting patient perceptions of subsequent session outcome. The study focused on 2 potential indicators: time in treatment and treatment efficacy. Method: Data of 107 treatment completers assigned to either cognitive-behavioral therapy or alliance focused therapy were analyzed. Data included session-to-session assessments of alliance and the session outcome measure across the 30 weeks of treatment as well as pretreatment to posttreatment assessments of treatment efficacy using the Symptom Checklist-90–Revised. An actor-partner interdependence model of longitudinal hierarchically nested data, disentangled for within- and between-patients effects, was used. The interactive effects of time and treatment efficacy and their combined effect were examined. Results: At the sample level, as expected, the therapist perspective of alliance did not significantly predict patient perception of subsequent session outcome, but significant interaction effects were detected. Therapists’ perspective on the alliance was a stronger predictor of patients’ perception of subsequent session outcome when therapy was more rather than less effective. This effect was evident mainly early in treatment, during which greater variability across dyads was found. Conclusions: Findings suggest that although therapists’ ratings of the alliance are not consistently predictive of patients’ rating of subsequent session outcome, they are better predictors in more than in less effective treatments. (PsycINFO Database Record (c) 2018 APA, all rights reserved)