Clinical Psychology in Europe (E-Journal)
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Special Issue Editorial: Cultural Adaption of Psychological Interventions
No full textNo abstract available
Looking on the Bright Side Reduces Worry in Pregnancy: Training Interpretations in Pregnant Women
No full textBackground: Recent evidence suggests that anxiety is more common than depression in the perinatal period, however there are few interventions available to treat perinatal anxiety. Targeting specific processes that maintain anxiety, such as worry, may be one potentially promising way to reduce anxiety in this period. Given evidence that negative interpretation bias maintains worry, we tested whether interpretation bias could be modified, and whether this in turn would lead to less negative thought (i.e., worry) intrusions, in pregnant women with high levels of worry.Method: Participants (N = 49, at least 16 weeks gestation) were randomly assigned to either an interpretation modification condition (CBM-I) which involved training in accessing positive meanings of emotionally ambiguous scenarios, or an active control condition in which the scenarios remained ambiguous and unresolved.Results: Relative to the control condition, participants in the CBM-I condition generated significantly more positive interpretations and experienced significantly less negative thought intrusions.Conclusions: Our findings indicate that worry is a modifiable risk factor during pregnancy, and that it is possible to induce a positive interpretation bias in pregnant women experiencing high levels of worry. Although preliminary, our findings speak to exciting clinical possibilities for the treatment of worry and the prevention of perinatal anxiety
Body Exposure, its Forms of Delivery and Potentially Associated Working Mechanisms: How to Move the Field Forward
No full textBackground: Body image disturbance (BID) is a hallmark feature of eating disorders (EDs) and has proven to be involved in their etiology and maintenance. Therefore, the targeting of BID in treatment is crucial, and has been incorporated in various treatment manuals. One of the most common techniques in the treatment of BID is body exposure (BE), the confrontation with one’s own body. BE has been found to be effective in individuals with EDs or high body dissatisfaction. However, BE is applied in a multitude of ways, most of which are based on one or a combination of the hypothesized underlying working mechanisms, with no differential effectiveness known so far. Method: The aim of this paper is to selectively review the main hypothesized working mechanisms of BE and their translation into therapeutic approaches. Results and Conclusion: Specifically, we underline that studies are needed to pinpoint the proposed mechanisms and to develop an empirically informed theoretical model of BE. We provide a framework for future studies in order to identify working mechanisms and increase effectiveness of BE
The Cooperative Revolution Reaches Clinical Psychology and Psychotherapy: An Example From Germany
No full textBackground: Psychology is at the beginning of a cooperative revolution. Traditionally, psychological research has been conducted by individual labs, limiting its scope in clinical samples and promoting replication problems. Large-scale collaborations create new opportunities for highly powered studies in this resource-intensive research area. To present the current state of a Germany-wide platform for coordinating research across university outpatient clinics for psychotherapy. Method: Since 1999, over 50 such clinics were created in Germany. They represent a unique infrastructure for research, training, and clinical care. In 2013, a steering committee initiated a nationwide research platform for systematic coordination of research in these clinics (German abbreviation “KODAP”). Its main goal is to aggregate and analyze longitudinal treatment data – including patient, therapist, and treatment characteristics – across all participating clinics. Results: An initial survey (100% response rate) yielded recommendations for improved integration of data collection. Pilot data from 4,504 adult (16 clinics) and 568 child and adolescent patients (7 clinics) proved feasibility of data transfer and aggregation despite different data formats. Affective, neurotic, stress, and somatoform (adults) and anxiety and behavioral (children and adolescents) disorders were most frequent; comorbidity was high. Overcoming legal, methodological, and technical challenges, a common core assessment battery was developed, and data collection started in 2018. To date, 42 clinics have joined. Conclusions:KODAP shows that research collaboration across university outpatient clinics is feasible. Fulfilling the need for stronger cumulative and cooperative research in Clinical Psychology will contribute to better knowledge about mental health, a core challenge to modern societies
Item Response Model Validation of the German ICD-11 International Trauma Questionnaire for PTSD and CPTSD
No full textBackground: In the 11th revision of the International Classification of Diseases (ICD-11) posttraumatic stress disorder (PTSD) and the complex variant (CPTSD) were newly conceptualised. The International Trauma Questionnaire (ITQ) was developed as a brief self-report measure to screen for both disorders. The English original version has been rigorously tested and presents convincing psychometric properties. The aim of the current study was to validate the German version by means of item response theory (IRT).Method: This is a secondary analysis of a representative, trauma-exposed adult sample from the German general population (N = 500). 1- and 2-parameter logistic IRT models (i.e. examination on an item level), diagnostic rates and confirmatory factor analyses were calculated.Results: All items showed good model fit and acceptable to good performance aligning with the items of the English original except for item C1 (Long time to calm down) which had a high endorsement rate and a low discriminatory power yielding low information gain. CPTSD diagnostic rate of 3.2% was lower than in comparable literature. Confirmatory factor analysis deemed the six first-order, two second-order factors model superior.Conclusion: Measurement and factorial validity of the German version of the ITQ was confirmed. The German translation matches the English original in most psychometric properties and can thus be used for research and clinical practice
A Brief History of Aaron T. Beck, MD, and Cognitive Behavior Therapy
No full textNo abstract available
Prospective Mental Imagery in Depression: Impact on Reward Processing and Reward-Motivated Behaviour
No full textBackground: Mental imagery has long been part of cognitive behavioural therapies. More recently, a resurgence of interest has emerged for prospective mental imagery, i.e. future-directed imagery-based thought, and its relation to reward processing, motivation and behaviour in the context of depression.Method: We conducted a selective review on the role of prospective mental imagery and its impact on reward processing and reward-motivated behaviour in depression.Results: Based on the current literature, we propose a conceptual mechanistic model of prospective mental imagery. Prospective mental imagery of engaging in positive activities can increase reward anticipation and reward motivation, which can transfer to increased engagement in reward-motivated behaviour and more experiences of reward, thereby decreasing depressive symptoms. We suggest directions for future research using multimodal assessments to measure the impact of prospective mental imagery from its basic functioning in the lab to real-world and clinical implementation.Conclusion: Prospective mental imagery has the potential to improve treatment for depression where the aim is to increase reward-motivated behaviours. Future research should investigate how exactly and for whom prospective mental imagery works
Standardised Research Methods and Documentation in Cultural Adaptation: The Need, the Potential and Future Steps
No full textBackground: Refugees and asylum seekers in Europe are affected by high prevalence of common mental disorders. Under the call ‘mental health of refugee populations’, the German Federal Ministry of Education and Research (FMER) funded a series of research projects to test evidence-based psychological interventions among refugee populations in Germany. In addition, the “Task force for cultural adaptation of mental health interventions for refugees” was established to develop a structured procedure for harmonising and documenting cultural adaptations across the FMER-funded research projects.Method: A template for documenting cultural adaptations in a standardised manner was developed and completed by researchers in their respective projects. Documentation contained original data from formative research, as well as references and other sources that had been used during the adaptation process. All submitted templates and additional materials were analysed using qualitative content analysis.Results: Research projects under the FMER call include minors, adults, and families from different origins with common mental disorders. Two studies used and adapted existing manuals for the treatment of PTSD. Four studies adapted existing transdiagnostic manuals, three of which had already been developed with a culture-sensitive focus. Four other studies developed new intervention manuals using evidence-based treatment components. The levels of cultural adaptation varied across studies, ranging from surface adaptations of existing manuals to the development of new, culture-sensitive interventions for refugees.Conclusions: Cultural adaptation is often an iterative process of piloting, feedback, and further adaptation. Having a documentation system in place from start helps structuring this process and increases transparency
Qualitative Approximations to Causality: Non-Randomizable Factors in Clinical Psychology
No full textBackground: Causal quests in non-randomized studies are unavoidable just because research questions are beyond doubt causal (e.g., aetiology). Large progress during the last decades has enriched the methodical toolbox.Aims: Summary papers mainly focus on quantitative and highly formal methods. With examples from clinical psychology, we show how qualitative approaches can inform on the necessity and feasibility of quantitative analysis and may yet sometimes approximate causal answers.Results: Qualitative use is hidden in some quantitative methods. For instance, it may yet suffice to know the direction of bias for a tentative causal conclusion. Counterfactuals clarify what causal effects of changeable factors are, unravel what is required for a causal answer, but do not cover immutable causes like gender. Directed acyclic graphs (DAGs) address causal effects in a broader sense, may give rise to quantitative estimation or indicate that this is premature.Conclusion: No method is generally sufficient or necessary. Any causal analysis must ground on qualification and should balance the harms of a false positive and a false negative conclusion in a specific context
Cultural Adaptation of CBT for Afghan Refugees in Europe: A Retrospective Evaluation
No full textBackground: Culturally adapted CBT (CA CBT+) is a well-evaluated, culture-sensitive intervention for refugees that utilizes psychoeducation, problem solving training, meditation, and stretching exercises. However, there is a lack of standard procedures for adapting psychotherapeutic interventions to a specific cultural context. Our working group adapted CA CBT for Afghan refugees at two different stages, which yielded promising results from a pilot trial and an RCT with a waitlist control group. This article aimed to illustrate the ongoing adaptation process of CA CBT+ for Afghan refugees over the course of several trials and to highlight potential limitations by evaluating how systematic adaptations were performed.Method: The adaptation process of CA CBT+ was described in detail, including the methods and rationale for changes to the protocol. This process was analyzed according to a new set of proposed reporting criteria. Results: According to the defined target population and based on multiple research strategies, culturally-specific components, such as the rationales for interventions, metaphors, and idioms of distress, were adapted. Relevant surface adaptations were implemented. However, although the steps of our adaptation process corresponded with the reporting criteria, some of the adaptation processes did not follow explicit criteria but resulted from implicit judgments.Conclusion: In the future, compliance with and the documentation of adaptation processes following explicit guidelines are crucial for the transfer of evidence-based approaches for managing the diversity of refugee populations