Clinical Psychology in Europe (E-Journal)
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Selected Trends in Psychotherapy Research: An Index Analysis of RCTs
No full textBackground: We wanted to analyze trends in psychotherapy research during the last decade. We used published randomized clinical trials (RCTs) that are cited in Web of Science (WoS) as an index for these activities.
Method: We searched for RCTs published between the years 2010 and 2019. Search criteria included cognitive-behavioral treatments (CBT), e-mental health, Acceptance and Commitment Therapy (ACT), psychodynamic treatments, interpersonal therapy (IPT), schema therapy, systemic therapy, mindfulness treatments, and emotion-focused therapy (EFT). The numbers of publications for each treatment approach were accumulated for 5-year blocks (2010 to 2014; 2015 to 2019).
Results: The search revealed 4,523 hits for the selected treatment options, of which 1,605 were finally included in the analysis. There was a continuous increase in published RCTs, with 68% more trials during the second five-year block. CBT (68%) and eHealth interventions (18%) show an increase in the number of studies, but there were no significant changes in its percentage in relation to all published RCTs. The next frequent treatments were ACT (4%), psychodynamic treatments (2%), IPT (2%), and mindfulness interventions (2%). We found a significant increase of the percentage of mindfulness (p = .008) and a significant decrease of the percentage of psychodynamic treatments (p = .02). Systemic (1.1%), emotion-focused (0.7%) and schema therapy (0.6%) represented smaller parts of published RCTs.
Conclusion: A continuous increase of published RCTs underlines an active field of research on psychological interventions. Third wave treatments such as mindfulness increased their representation in research, while the part of psychodynamic treatments decreased
Paul Emmelkamp Becomes “Ambassador of Clinical Psychology and Psychological Treatment”
No full textNo abstract available
Premature Dropout From Psychotherapy: Prevalence, Perceived Reasons and Consequences as Rated by Clinicians
No full textBackground: Why clients discontinue their psychotherapies has attracted more attention recently as it is a major problem for many healthcare services. Studies suggest that dropout rates may be affected by the mode of therapy, low-quality therapeutic alliance, low SES, and by conditions such personality disorders or substance abuse. The aims of the study were to investigate what happens in therapies which end in a dropout, and to estimate how common dropout is as reported by practicing clinicians.
Method: An online questionnaire was developed and completed by 116 therapists working in clinical settings. They were recruited via social media (Facebook and different online psychotherapy groups) in Sweden and worked with Cognitive Behavioural Therapy (CBT), Psychodynamic Therapy (PDT), Interpersonal Psychotherapy (IPT) and Integrative Psychotherapy (IP).
Results: Psychotherapists rated the frequency of premature dropout in psychotherapy to be on average 8.89% (MD = 5, SD = 8.34, Range = 0-50%). The most common reasons for a dropout, as stated by the therapists, were that clients were not satisfied with the type of intervention offered, or that clients did not benefit from the treatment as they had expected. The most common feeling following a dropout was self-doubt.
Conclusion: In conclusion, premature dropout is common in clinical practice and has negative emotional consequences for therapists. Premature dropout may lead to feelings of self-doubt and powerlessness among therapists. The therapeutic alliance was mostly rated as good in dropout therapies. Further research is needed to validate the findings with data on the prevalence and subjective reasons behind a dropout from point of view of clients
Early Adverse Effects of Behavioural Preventive Strategies During the COVID-19 Pandemic in Germany: An Online General Population Survey
No full textBackground: Quarantine and physical distancing represent the two most important non-pharmaceutical actions to contain the COVID-19 pandemic. Comparatively little is known about possible adverse consequences of these behavioural measures in Germany. This study aimed at investigating potential early adverse effects associated with quarantine and physical distancing at the beginning of the countrywide lockdown in Germany in March 2020. Method: Using a cross-sectional online survey (N = 4,268), adverse consequences attributed to physical distancing, symptoms of psychopathology, and sociodemographic variables were explored in the total sample as well as in high-risk groups (i.e., people with a physical or mental condition). Results: The most frequently reported adverse effects were impairment of spare time activities, job-related impairment, and adverse emotional effects (e.g., worries, sadness). Participants with a mental disorder reported the highest levels of adverse consequences (across all domains) compared to participants with a physical disease or participants without any mental or physical condition. No significant association between the duration of the behavioural protective measures and the severity of adverse mental health effects was observed. Conclusion: Results showed that non-pharmaceutical actions were associated with adverse effects, particularly in people with mental disorders. The findings are of relevance for tailoring support to special at-risk groups in times of behavioural preventive strategies
Symptom Perceptions in Functional Disorders, Major Health Conditions, and Healthy Controls: A General Population Study
No full textBackground: The present study investigated differences in symptom perceptions between individuals with functional disorders (FD), major health conditions, and FDs + major health conditions, respectively, and a group of healthy individuals. Furthermore, it investigated the relevance of FDs among other health-related and psychological correlates of symptom perceptions in the framework of the Common Sense Model of Self-Regulation (CMS). Method: This cross-sectional study used epidemiological data from the Danish Study of Functional Disorders part two (N = 7,459 participants, 54% female, 51.99 ± 13.4 years). Symptom perceptions were assessed using the Brief Illness Perception Questionnaire (B-IPQ) and compared between the four health condition groups. Multiple regression analyses were performed to examine associations between symptom perceptions, FDs, and other health-related and psychological correlates from the CMS framework. Results: Individuals with FDs (n = 976) and those with FDs + major health conditions (n = 162) reported less favorable symptom perceptions compared to the other two groups, particularly regarding perceived consequences, timeline, and emotional representations (effect size range Cohen’s d = 0.12-0.66). The presence of a FD was significantly associated with all B-IPQ items, even in the context of 16 other relevant health-related and psychological correlates from the CMS framework, whereas symptom presence last year or last week was not. Conclusion: In the general population, symptom perceptions seem to play a more salient role in FD than in individuals with well-defined physical illness. Symptom perceptions should therefore be targeted in both primary and secondary interventions for FDs
From Broken Models to Treatment Selection: Active Inference as a Tool to Guide Clinical Research and Practice
No full textNo abstract available
Psychological Processes Associated With Resilience in UK-Based Unpaid Caregivers During the COVID-19 Pandemic
No full textBackground: Unpaid caregivers have faced and dealt with additional challenges during the COVID-19 pandemic. Understanding the psychological processes associated with their resilience is warranted. The objective of this study was to examine the associations between resilience with mental distress, emotion regulation strategies (i.e., reappraisal and suppression) and interpretation bias in adult caregivers. Method: Participants were living in the UK, aged 18+, and consisted of 182 unpaid caregivers of an adult aged 18+ living with a long-term health condition, and 120 non-caregivers. Data were collected in an online study during the first national UK COVID-19 lockdown (May and September 2020). Hierarchical multiple regression analyses explored whether emotion regulation strategies and interpretation bias explained unique variance in levels of resilience in caregivers whilst controlling for anxiety and depression. Results: Compared to non-caregivers, caregivers reported higher levels of anxiety, depression, negative interpretation bias and lower levels of resilience. Emotion regulation strategies did not differ between groups. Within caregivers, greater resilience was associated with lower mood disturbance, a positive interpretation bias, and greater use of cognitive reappraisal and lower use of suppression strategies to regulate emotions. Emotion regulation and interpretation bias together predicted an additional 15% of variance in current levels of resilience. Conclusion: Our findings indicate that psychological mechanisms such as emotion regulation strategies, particularly reappraisal, and interpretation bias are associated with resilience in caregivers. Although preliminary, our findings speak to exciting clinical possibilities that could form the target of interventions to improve resilience and lower mental distress in unpaid caregivers
Widespread Recommendations Can Change Our Habits of Hand-Washing and Physical Distance During the COVID-19 Pandemic
No full textBackground: Habits and behaviors in everyday life currently need to be modified as quickly as possible due to the COVID-19 pandemic. Two of the most effective tools to prevent infection seem to be regular and thorough hand-washing and physical distancing during interpersonal interactions. Method: Two hundred and eighty-four participants completed a short survey to investigate how previous habits regarding hand-washing and physical distancing have changed in the general population as a function of the current pandemic and the thereby increased information and constant recommendations regarding these behaviors. Results: Participants aged 51 and older reported a greater change in everyday hand-washing behavior than younger participants. In addition, participants aged 31 and older selected significantly greater distances to have a conversation than younger participants. However, that was not the case if participants had to actively stop their conversational partner from approaching. Conclusion: Participants aged 51 years and older seem to be well aware of their at-risk status during the current pandemic and might therefore be willing to change their behavior more strongly than younger survey participants. Nevertheless, they seem to struggle with enforcing the current rules towards others. The group aged between 31 and 50 years, however, reports a comparable level of fear, but no corresponding change in hand-washing behavior. Future surveys should try to provide more insight into why this might be the case
Has the Time Come to Stop Using the “Standardised Mean Difference”?
No full textBackground: Most meta-analyses use the ‘standardised mean difference’ (effect size) to summarise the outcomes of studies. However, the effect size has important limitations that need to be considered. Method: After a brief explanation of the standardized mean difference, limitations are discussed and possible solutions in the context of meta-analyses are suggested. Results: When using the effect size, three major limitations have to be considered. First, the effect size is still a statistical concept and small effect sizes may have considerable clinical meaning while large effect sizes may not. Second, specific assumptions of the effect size may not be correct. Third, and most importantly, it is very difficult to explain what the meaning of the effect size is to non-researchers. As possible solutions, the use of the ‘binomial effect size display’ and the number-needed-to-treat are discussed. Furthermore, I suggest the use of binary outcomes, which are often easier to understand. However, it is not clear what the best binary outcome is for continuous outcomes. Conclusion: The effect size is still useful, as long as the limitations are understood and also binary outcomes are given