Clinical Psychology in Europe (E-Journal)
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Dropout From Trauma-Focused Treatment for PTSD in a Naturalistic Setting
No full textBackground: Although evidence-based interventions for posttraumatic stress disorder (PTSD) are highly effective, on average about 20% of patients drop out of treatment. Despite considerable research investigating PTSD treatment dropout in randomized controlled trials (RCTs), findings in naturalistic settings remain sparse. Objective: Therefore, the present study investigated the frequency and predictors of dropout in trauma-focused interventions for PTSD in routine clinical care. Method: The sample included n = 195 adults with diagnosed PTSD, receiving trauma-focused, cognitive behavioral therapy in routine clinical care in three outpatient centers. We conducted a multiple logistic regression analysis with the following candidate predictors of dropout: patient variables (e.g., basic sociodemographic status and specific clinical variables) as well as therapist’s experience level and gender match between therapist and patient. Results: Results showed a dropout rate of 15.38%. Age (higher dropout probability in younger patients) and living situation (living with parents predicted lower dropout probability compared to living alone) were significant predictors of dropout. Dropout was not significantly associated with the therapist’s experience level and gender match. Conclusions: In conclusion, routinely assessed baseline patient variables are associated with dropout. Ultimately, this may help to identify patients who need additional attention to keep them in therapy
Response to the Commentary „Can a 1-Item Scale for Psychotherapy Outcomes Be Psychometrically Robust?”
No full textNo abstract available
A Journey Through Time – Study Protocol for a Randomized Controlled Trial Testing the Add-on Effects of Imagery Rescripting to Ongoing Cognitive Behavioural Therapy in Patients With Depressive Disorders
No full textBackground: Patients with depression often report recurring memories of stressful events from the past (e.g. experiences of rejection, emotional or physical abuse). These distressing memories, commonly dating back to childhood, can contribute to the development and maintenance of depression through their impact on cognitive schemas. The method of imagery rescripting (ImRs) addresses distressing memories and the associated emotions directly: With therapeutic support, patients recall the respective memory and modify the memory during imagination in such a way that the emotional quality and meaning of the memory changes. In this randomized trial, we will assess the impact of a three-session ImRs intervention within standard cognitive behaviour therapy (CBT) for depression, comparing it to an active control intervention (imagery relaxation). Method: Sixty-six patients with MDD who are currently receiving treatment (CBT) will be randomized to either (1) the experimental condition (ImRs) or (2) the control condition (imagery relaxation). Reduction of depressive symptoms, measured by the Beck Depression Inventory (BDI-II) is the primary outcome. The BDI-II will be assessed at baseline, post-intervention, and at 4-week and 8-week follow-ups. Discussion: This study will help to clarify whether adding three ImRs sessions improves the effectiveness of CBT for depression. We outline the next steps for future research and highlight the potential of this novel intervention for depression
The Effect of Depression and Hopelessness on Suicidal Risk in Young People: The Mediating Role of Impulsivity
No full textBackground: Previous studies have documented that depression and hopelessness predict higher suicide risk in young people. However, the psychological mechanisms that may mediate these associations are unknown. The aim of this study was to analyze the effects of depression, hopelessness, and impulsivity on suicidal attempts and risk, and to explore the mediating role of impulsivity in these associations. Method: A total of 1,645 young people participated with a mean age of 21.604 years (SD = 3.22) (68.8% female and 31.2% male). A sociodemographic form was applied to explore suicide attempts in the last year (SA), the Plutchik Suicide Risk (SR), Beck Hopelessness (BHS), Barratt Impulsivity (BIS), and Beck Depression Inventory (BDI) scales. Direct correlations were found among BHS, BDI, BIS, SA, and SR. Results: The binary regression model showed that the variables BHS, BDI, and BIS explained between 33% and 49% of the variance of suicidal risk and 16% of the variance of suicide attempts. Structural equation analysis showed that impulsivity mediated the associations between depression, hopelessness, and suicidal risk, on the one hand, and mediated the associations between depression and suicide attempt, on the other hand, whose total direct and indirect effects were statistically significant. Conclusion: The findings emphasize the importance of impulsivity as the mechanism influencing interactions between mood indicators and suicidal behavior in young populations
Empirically Informed, Idiographic Networks of Concordant and Discordant Motives: An Experience Sampling Study With Network Analysis in Non-Clinical Participants
No full textBackground: Case formulations and treatment planning mostly rely on self-reports, observations, and third-party reports. We propose that these data sources can be complemented by idiographic networks of motive interactions, which are empirically derived from everyday life using the Experience Sampling Method (ESM). In these networks, positive edges represent concordance of motives whereas negative edges indicate discordance. Based on consistency theory, which states that discordance emerges when the activity of one motive (e.g., ‘affiliation’) is incompatible with the activity of another motive (e.g., ‘autonomy’), we hypothesized that discordance would be associated with subclinical depressive symptoms. Method: Fifty-one undergraduates completed a six-day ESM assessment period with 6 assessments of motive satisfaction per day. Based on the ESM data, idiographic networks of the seven most important motives per person were computed using mlVAR (https://doi.org/10.32614/CRAN.package.mlVAR). We extracted indices of motive dynamics from each person’s network, namely the strength of negative edges compared to the overall network strength as well as the values of the single most negative and positive edges. These indices were then used to predict subclinical depressive symptoms, controlling for overall motive satisfaction. Results: Discordant, conflicting motive relationships made up only 6% of network strengths, indicating high concordance overall. Neither conflict index predicted subclinical depressive symptoms but maximum concordance was associated with lower subclinical depressive symptoms. Motive satisfaction was a significant predictor across models. Conclusion: The applicability and clinical utility of the motive network approach was promising. Insufficient variance due to a healthy sample and the small number of observations limit the interpretability of findings
Transdiagnostic Network Mapping of Psychopathology in Daily Life: Rationale and Research Protocol
No full textBackground: The burden of mental health problems and the need for more effective interventions is well established. One path towards treatment improvement involves more effective (evidence-based) tailoring, which requires a deeper understanding of differences in individual profiles of psychopathology. The network approach to mental disorders has emerged as a promising framework in this regard, as it sees and assesses psychopathology as individual networks of interacting symptoms and other variables and uses analysis methods that allow fine-grained analyses of (differences in) individual processes. Method: We describe the protocol of a 6-week ecological momentary assessment (EMA) study in a broad clinical population, designed to capture various transdiagnostic psychopathology relevant states. Participants are Dutch adults (desired = 600) who are currently awaiting intake- or start of treatment for psychopathology. In addition to EMA self-reports, we collect digital phenotyping data, a broad range of baseline data on symptomatology and transdiagnostic traits, and diagnostic classifications after intake. The study’s primary aims are to estimate individual- and group networks of psychopathology (identifying), explore what factors can explain individual differences in networks (linking), and identify potential subgroups based on the networks (clustering). Finally, we plan to evaluate the measures and procedures to facilitate future transdiagnostic EMA (network) research. Discussion: The prospective study findings have the potential to advance the description, prediction, and assessment of psychopathology and to evaluate the utility of the network framework in achieving these aims. The insights gained may facilitate the evaluation and refinement of current classifications of mental health conditions and alternative transdiagnostic approaches
Can a 1-Item Scale for Psychotherapy Outcomes Be Psychometrically Robust?
No full textNo abstract available
IBD-Specific Cognitive Behavioral Therapy: Sustainability of Effect After Three Years
No full textBackground and Aims: ‘Inflammatory Bowel Disease (IBD)-specific-Cognitive-Behavioral Therapy’ (CBT) is effective in improving Quality of Life (QoL) and in decreasing anxiety and depression in IBD-patients with poor mental QoL, one month after completing CBT. Main aim was to examine the sustainability of treatment effects up to three years after treatment with CBT. Method: Participants (n = 118) of a previously conducted randomized-control-study on the effects of ‘IBD-specific-CBT’ for IBD-patients were contacted for a long-term follow-up assessment on main outcomes: generic and IBD-specific-QoL (SF-36, IBDQ), anxiety and depression (HADS, CES-D) and DSM-IV disorders (SCID-I). Change over time was examined with multilevel-regression-analyses. Results: Three years after finishing ‘IBD-specific-CBT’, 61 IBD-patients (response rate 52%) completed the follow-up SCID-I assessment and 52 patients (response rate 44%) completed the assessments for symptomatology. There were no differences between dropouts and participants at three year follow-up, except for a longer disease duration in dropouts. At three-year follow-up the chance of patients having a DSM-disorder significantly decreased with an estimated 48% (from 87% at baseline to 38% at follow-up). Multilevel analyses showed a significant improvement between baseline (n = 118) and follow-up measurements (n = 52) on outcomes: IBDQ-Total (Cohen’s d effect-size = .89), SF-36 Physical (d = .54), and SF-36 Mental (d = .69), HADS-A (d = -.77), HADS-D (d = -.65) and CES-D (d = -.55); all p < .01. QoL outcomes showed further improvement between completion (n = 90 for IBD-specific QoL and n = 91 for generic QoL) and follow-up measurements, with significant improvements for IBDQ-Total (d = 0.31) and SF-36 Physical (d = 0.32). Conclusions: Sustainable positive effects of ‘IBD-specific-CBT’ for IBD-patients with poor mental QoL were found and the prevalence of mental conditions substantially decreased over three year follow-up
A Remote Adapted Physical Activity Intervention for Women With Breast Cancer and Severe Depressive or Anxiety Symptoms: Series of N-of-1 Trials With Ecological Momentary Assessment
No full textBackground: Women with breast cancer live with the burden of the disease, its treatment, and the psychosocial consequences of illness, often contributing to the experience of psychological distress. At this end, physical activity (PA) is an evidence-based strategy to decrease depressive and anxiety symptoms. However, no study has yet investigated how those psychological symptoms fluctuate and vary during a PA intervention at the individual level, especially for individuals with severe psychological distress. Thus, the aim of the present study was to examine the short-term effects of a 12-week remote PA intervention on daily level of depressive and anxiety symptoms among women with breast cancer and severe depressive or anxiety symptoms. Method: A N-of-1 study followed an ABA’ design was conducted. Each A phase (2-week) represents pre- and post-intervention phase and B phase (12-week) represents the intervention phase. For the whole 16 weeks, participants received a daily prompt to report their depressive and anxiety levels. The intervention combined two to three (un)supervised remote PA sessions per week coupled with weekly text messages. Results: Sixteen participants completed the intervention. A significant decrease of depressive and anxiety symptoms was found for nine and seven participants, respectively. Different temporal patterns of depressive and anxiety were observed during and after the intervention. Interestingly, the impact of PA intervention was generally not immediate and gradual. Conclusion: This study supports the utility of remote PA intervention to improve depressive and anxiety symptoms in women with breast cancer and poor mental health
Assessing Perinatal Psychiatric Morbidity: Implications for Maternal Mental Health Care in Italy
No full textBackground: Traumatic births impact women’s long-term health, family dynamics, and healthcare systems, underscoring the need for prevention and effective interventions. Despite Italy's universal healthcare, perinatal mental health services and guidelines, especially for childbirth-related PTSD (CB-PTSD), remain underdeveloped. This study aims to investigate the prevalence of CB-PTSD, postpartum depression (PPD), and anxiety in Italian women 6-12 weeks postpartum, and assess the impact of comorbidities on mother-child bonding. Method: The study was part of a broader longitudinal research that involved 175 Italian mothers 6-12 weeks postpartum, recruited from birthing centers. Participants completed measures for childbirth-related PTSD (City BiTS-IT), depression (EPDS), anxiety (PSAS-IT), and mother-child bonding (PBQ). Results: Prevalence rates were 1.1% for CB-PTSD, 18.6% for depression, and 30.2% for anxiety. Depression was significantly associated with anxiety (χ2(1, N = 159) = 9.131, p = .003) and CB-PTSD (χ2(1, N = 171) = 11.689, p < .001). Hierarchical regression showed that depression and general PTSD symptoms significantly impaired mother-child bonding, explaining 36.3% of the variance (R2 = 0.363). Conclusion: The findings highlight the prevalence and complexity of perinatal psychiatric morbidity, emphasizing the critical need for comprehensive assessment tools tailored to the Italian context. These results contribute to a deeper understanding of maternal mental health challenges during the perinatal period