Clinical Psychology in Europe (E-Journal)
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Correction of Abeditehrani, H., Dijk, C., Sahragard Toghchi, M., & Arntz, A. (2020). Integrating Cognitive Behavioral Group Therapy and Psychodrama for Social Anxiety Disorder: An Intervention Description and an Uncontrolled Pilot Trial
No full textCorrection to:Abeditehrani, H., Dijk, C., Sahragard Toghchi, M., & Arntz, A. (2020). Integrating cognitive behavioral group therapy and psychodrama for social anxiety disorder: An intervention description and an uncontrolled pilot trial. Clinical Psychology in Europe, 2(1), Article e2693. https://doi.org/10.32872/cpe.v2i1.269
Medication-Enhanced Psychotherapy for Posttraumatic Stress Disorder: Recent Findings on Oxytocin’s Involvement in the Neurobiology and Treatment of Posttraumatic Stress Disorder
No full textBackground: Traumatic experiences may result in Posttraumatic Stress Disorder (PTSD), which is characterized as an exaggerated fear response that cannot be extinguished over time or in safe environments. What are beneficial psychotherapeutic treatment options for PTSD patients? Can oxytocin (OXT), which is involved in the stress response, and safety learning, ameliorate PTSD symptomatology and enhance psychotherapeutic effects? Here, we will review recent studies regarding OXT’s potential to enhance psychotherapeutic therapies for PTSD treatment.Method: We conducted a literature review on the neurobiological underpinnings of PTSD especially focusing on OXT’s involvement in the biology and memory formation of PTSD. Furthermore, we researched successful psychotherapeutic treatments for PTSD patients and discuss how OXT may facilitate observed psychotherapeutic effects.Results: For a relevant proportion of PTSD patients, existing psychotherapies are not beneficial. OXT may be a promising candidate to enhance psychotherapeutic effects, because it dampens responses to stressful events and allows for a faster recovery after stress. On a neural basis, OXT modulates processes that are involved in stress, arousal and memory. OXT effectively counteracts memory impairments caused by stress and facilitates social support seeking which is a key resilience factor for PTSD and which is beneficial in psychotherapeutic settings.Conclusion: OXT has many characteristics that are promising to positively influence psychotherapy for PTSD patients. It potentially reduces intrusions, but preserves memory of the event itself. Introducing OXT into psychotherapeutic settings may result in better treatment outcomes for PTSD patients. Future research should directly investigate OXT’s effects on PTSD, especially in psychotherapeutic settings
Dysfunctional Cognition in Individuals With an Increased Risk for Mania
No full textBackground: There is still a lack of knowledge about attitudes and cognitions that are related to bipolar disorder. Theoretically, it was proposed that exaggerated beliefs about the self, relationships, the need for excitement, and goal-related activities might lead to mania in vulnerable individuals, however, the few studies that examined this hypothesis provided mixed results. One of the unresolved issues is if such a cognitive style is associated with current mood symptoms or with different stages of the illness, i.e. at-risk versus diagnosed bipolar disorder. Therefore, the present study aimed at evaluating depression and mania-related cognitive style in individuals at-risk for mania. Method: In an online survey, we collected data of 255 students of the University of Klagenfurt, Austria. All participants completed the Hypomanic Personality Scale (HPS), the Cognition Checklist for Mania – Revised (CCL-M-R), the Dysfunctional Attitude Scale (DAS), the Beck Depression Inventory (BDI), and the Internal State Scale (ISS). Results: In a hierarchical regression, HPS was positively related to scores of all subscales of the CCL-M-R. The HPS did not significantly predict scores of the DAS. Current manic and depressive symptoms significantly contributed to the models. Conclusion: The present results suggest that a trait-like risk for mania is associated with mania-related but not depression-related cognitions
STARC-SUD – Adaptation of a Transdiagnostic Intervention for Refugees With Substance Use Disorders
No full textBackground: Refugees often suffer from multiple mental health problems, which transdiagnostic interventions can address. STARC (Skills-Training of Affect Regulation – A Culture-sensitive Approach) is a culturally sensitive transdiagnostic group intervention that has been developed for refugees to improve affect regulation. In refugees with substance use disorders (SUD), the consideration of SUD-specific elements might improve the acceptance and effectiveness of such an intervention. We aimed to adapt the STARC program for refugees with SUD in a culturally sensitive way.Method: The conceptual framework of Heim and Kohrt (2019) was used to culturally sensitively adapt the STARC program to the needs of Syrian refugees with SUD. The results of five focus group discussions with refugees on cultural concepts of SUD and their treatment informed the adaption. An expert group suggested adaptions and decided by consensus on their implementation. Two pilot groups were conducted with the adapted STARC-SUD program. Interviews with the therapists of these pilot groups informed further adaption.Results: The concepts related to SUD identified in focus groups and therapists’ interviews that differed from Western concepts were integrated into the STARC intervention.Discussion: Further studies should assess the acceptance and effectiveness of the culturally sensitive STARC-SUD program for refugees with SUD
Explaining the Efficacy of an Internet-Based Behavioral Activation Intervention for Major Depression: A Mechanistic Study of a Randomized-Controlled Trial
No full textBackground: Behavioral activation is an effective treatment for depression that is theorized to facilitate structured increases in enjoyable activities that increase opportunities for contact with positive reinforcement; to date, however, only few mechanistic studies focused on a standalone intervention. Method: Interventions using internet-based behavioral activation or psychoeducation were compared based on data from a randomized-controlled trial of 313 patients with major depressive disorder. Activation level and depression were measured fortnightly (baseline, Weeks 2, 4, 6, 8, 10), using the Patient Health Questionnaire-9 and the Behavioral Activation for Depression Scale-Short Form, respectively. Analysis was performed to determine if a change in activation level mediated treatment efficacy. Results: Latent growth modeling showed that internet-based behavioral activation treatment significantly reduced depressive symptoms from baseline to the end of treatment (standardized coefficient = −.13, p = .017) by increasing the rate of growth in the activation level (mediated effect estimate = −.17, 95% CI [−.27, −.07]. Results from mixed effects and simplex models showed that it took 4 weeks before mediation occurred (i.e., a significant change in activation that led to a reduction in depressive symptoms). Conclusion: Activation level likely mediated the therapeutic effect of behavioral activation on depression in our intervention. This finding may be of significant value to clinicians and depressed individuals who should anticipate a 4-week window before seeing a prominent change in activation level and a 6-week window before depressive symptomatology reduces. Future research must consolidate our findings on how behavioral activation works and when mediation occurs
Evaluation of the Factor Structure and Psychometric Properties of the German Version of the Clinical Perfectionism Questionnaire: The CPQ-D
No full textBackground: The aim was to create a German version of the Clinical Perfectionism Questionnaire (CPQ-D) and to test its factor structure, reliability, and validity in a non-clinical population.Method: We recruited N = 432 participants via an online panel. The factor structure of CPQ-D was examined. The convergent, discriminative, and incremental validity was assessed in relation to the Frost Multidimensional Perfectionism Scale (FMPS) and the Positive and Negative Affect Schedule (PANAS).Results: Exploratory factor analysis resulted in two factors. Factor 1 represented the over evaluation of striving and Factor 2 was associated to concern over mistakes. Internal consistency was acceptable with ω = .81 for the total score, ω = .77 for Factor 1, and ω = .73 for Factor 2. Convergent, discriminative, and incremental validity was demonstrated. Important to note, Item 12 should be used with caution since it showed low communality and a low item-total correlation and should therefore be further evaluated in future research.Conclusion: The results indicate that the German translated version of the CPQ has acceptable internal consistency, convergent, discriminative and incremental validity. Future research should test the CPQ-D scale further in clinical and non-clinical populations and assess a broader variety of scales to determine validity of the scale
Integrating Cognitive Behavioral Group Therapy and Psychodrama for Social Anxiety Disorder: An Intervention Description and an Uncontrolled Pilot Trial
No full textBackground: Cognitive behavioral therapy (CBT) is generally considered to be the most effective psychological treatment for social anxiety disorder (SAD). Nevertheless, many patients with SAD are still symptomatic after treatment. The present pilot study aimed to examine integrating CBT, with a focus on cognitive and behavioral techniques, and psychodrama, which focuses more on experiential techniques into a combined treatment (CBPT) for social anxious patients in a group format. This new intervention for SAD is described session-by-session.Method: Five adult female patients diagnosed with social anxiety disorder participated in a twelve-session CBPT in a group format. Pretest and posttest scores of social anxiety, avoidance, spontaneity, cost and probability estimates of negative social events, depression, and quality of life were compared, as were weekly assessments of fear of negative evaluation.Results: Results demonstrated a significant reduction of the fear of negative evaluation and social anxiety symptoms. It is noteworthy that also the scores of the probability and cost estimates decreased. However, there were no significant differences between pre and post measures in any of other measures.Conclusion: The current study suggests that group CBPT might be an effective treatment for SAD. However, our sample size was small and this was an uncontrolled study. Therefore, it is necessary to test this intervention in a randomized controlled trial with follow-up assessments
Long-Term Stability of Benefits of Cognitive Behavioral Therapy for Obsessive Compulsive Disorder Depends on Symptom Remission During Treatment
No full textBackground: Cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD) and may afford stable long-term improvements. It is not clear, however, how stability or symptom recurrence can be predicted at the time of termination of CBT.
Method: In a 1-year follow-up intention-to-treat study with 120 OCD patients receiving individual CBT at a university outpatient unit, we investigated the predictive value of international consensus criteria for response only (Y-BOCS score reduction by at least 35%) and remission status (Y-BOCS score ≤ 12). Secondly, we applied receiver-operating characteristic (ROC) curves in order to find an optimal cut-off score to classify for deterioration and for sustained gains.
Results: Response only at post-treatment increased the likelihood of deterioration at follow-up compared to remission at an odds ratio of 8.8. Moreover, ROC curves indicated that a post-treatment score of ≥ 13 differentiated optimally between patients with and without symptom deterioration at follow-up assessment. The optimal cut-off score to classify for any sustained gains (response, remission, or both) at follow-up relative to baseline was 12. Importantly, previous findings of generally high long-term symptom stability after treatment in OCD could be replicated.
Conclusion: The findings highlight the clinical importance of reaching remission during CBT, and suggest that a recently published expert consensus for defining remission has high utility
Clinical Psychology in Lithuania: Current Developments in Training and Legislation
No full textThis paper presents an overview of the current status in training and legislation of clinical psychology in Lithuania. Clinical psychology training at the university level in Lithuania started soon after the collapse of the Soviet Union in the 1990s and was influenced by the social context and historical-political situation in the country. Currently, legislation for clinical psychology in Lithuania is in progress, and several promising regulations for psychology in health care were introduced in the last decade. However, psychologists, including clinical psychologists, are not licensed in Lithuania. The lack of legislation for psychology is the main obstacle for the recognition and establishment of clinical psychology in the country. In health care, the title ‘clinical psychologist’ is not common; ‘medical psychologist’ is the title used instead to refer to both clinical psychologists and health psychologists. We conclude that while the development of clinical psychology in Lithuania is promising, there is still a long way to go to establish clinical psychology as an important profession in Lithuania
Change Processes in Cognitive Therapy for Social Anxiety Disorder Delivered in Routine Clinical Practice
No full textBackground: Most studies examining processes of change in psychological therapy for social anxiety disorder (SAD) have analysed data from randomised controlled trials in research settings.Method: To assess whether these findings are representative of routine clinical practice, we analysed audit data from two samples of patients who received Cognitive Therapy for SAD (total N = 271). Three process variables (self-focused attention, negative social cognitions, and depressed mood) were examined using multilevel structural equation models.Results: Significant indirect effects were observed for all three variables in both samples, with negative social cognitions showing the strongest percent mediation effect. ‘Reversed’ relationships, where social anxiety predicted subsequent process variable scores, were also supported.Conclusion: The findings suggest the processes of change in this treatment may be similar between research trials and routine care