A Nonlinear Dynamical Systems Lens on Psychotherapy Process

Over the past 70 years, there has been an abundance of research indicating that psychotherapy works. However, the question of how therapy works has remained elusive. In fact, a therapist can follow a logical, systematic application of a specific therapy approach, but will still only have a vague sense of what is actually happening in the process over time and how that might relate to outcomes. Given the wide range of effective psychotherapy approaches that produce similar, positive outcomes, it is logical to conclude that there is something happening in the therapy process overtime that is more impactful than the approach itself. The purpose of this literature review is to view the empirical results on psychotherapy process through the lens of nonlinear dynamical systems theory in order to derive a more parsimonious set of processes that may be at work in facilitating positive treatment outcomes. Nonlinear dynamical systems (NDS) theory is a broad approach to science focusing on the potentially complex interactions of multivariate systems unfolding over time. NDS is aimed at understanding complex patterns. Two factors make NDS especially appealing for understanding psychotherapy process: 1) Linear science has been unable identify a set of independent predictors of outcome; 2) The targets of change in psychotherapy are themselves complex patterns of thought thought, behavior, emotion, and social relationships, each of which is interactive with the other and changing over time. The conclusions drawn from the existing research on psychotherapy process will be synthesized and used to form hypotheses that can be empirically tested using analogue and clinical research designs

The Effectiveness of Mindfulness-integrated Cognitive Behavioral Therapy (MiCBT), Meta-Cognitive Therapy (MCT), Acceptance and Commitment Therapy (ACT), and Cognitive Behavioral Therapy (CBT) on Obsessive-compulsive disorder (OCD)

Background: Due to the lack of a comparative study on the effectiveness of cognitive-behavioral approaches on Obsessive-compulsive disorder (OCD), this study aimed to compare the effectiveness of CBT, ACT, MCT, and MICBT on the symptoms of OCD patients. Methods: The research design was experimental, with pre-test, post-test, follow-up, and a control group. The research population comprised patients with OCD who are referred to Shiraz (Iran) Counseling centers in the first quarter of 2017 with a definitive diagnosis of OCD. Participants were elected and had been assigned to five groups of twenty individuals by random. The subjects have been evaluated before and after the intervention by the Yale-Brown questionnaire. Data are analyzed using repeated measure analysis of Anova via SPSS 21. Results: The findings showed that all four types of intervention, i.e., MiCBT, MCT, ACT, and CBT, were effective in improving short-term OCD symptoms. Also, there was no significant difference in the long-term (follow-up/one month) between the MCT and CBT approaches; while ACT and MiCBT have maintained their therapeutic effect in the follow-up. Conclusions: OCD can be treated with all the mentioned therapies in short term; but, only ACT and MiCBT can be helpful in the long term. Keywords: Obsessive-Compulsive Disorder (OCD), Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Meta-Cognitive Therapy (MCT), Mindfulness-integrated Cognitive Behavioral Therapy (MiCBT)

The psychometric properties of the Persian version of the contamination cognition scale (CCS)

Objective: In recent years, many researchers have been searching for effective cognitive factors in the development of obsessive-compulsive disorder (OCD). One of the scales designed to measure this characteristic is the contamination cognition scale (CCS) that evaluates 2 dimensions: overestimating the likelihood and severity of contamination. The aim of the present study was to evaluate the psychometric properties of the Persian version of CCS. Method: The study population of this descriptive psychometric study included students of Shahed University. A total of 490 students were selected via cluster sampling and completed the CCS. CCS was translated and back- translated before given to the students. The Obsessive Beliefs Questionnaire (OBQ) and the Padua Inventory (PI) were used. To assess the evidence for the validity of the scale, the exploratory and confirmatory factor analyses were used. The gathered data were analyzed by SPSS-22 and Amos-22 software. Results: The results of the confirmatory factor analysis (CFA) showed that one-factor model did not have adequate fitness (RMSEA > .05). Therefore, to explore the factors of this scale, exploratory factor analysis (EFA) was used, and it revealed 3 factors (public equipment, food, and restroom) for each of the dimensions (likelihood and severity). CFA by AMOS-22 confirmed the three-factor model (GFI, CFI, and NFI > .95; RMSEA < .05). Furthermore, the results supported criteria validity of CCS with the PI total score (0.56- 0.47, p < 0.001) and PI-contamination subscale (0.71-0.75, p < 0.001). Also, the correlation between CCS and responsibility/threat subscale of the OBQ was significant (0.47- 0.49, p < 0.001) The Cronbach's alpha for likelihood dimensions total was 0.93 and it was 0.94 for severity dimension total. The composite reliability was 0.95 for the likelihood dimension and 0.96 for severity dimension of CCS. Also, the test-retest reliability after a 4-week interval was confirmed (likelihood: r = 0.78; severity: r = 0.81, p < .001). Conclusion: The results indicated that one-factor model of CCS did not have adequate fitness, but three-factor model was confirmed in both dimensions (likelihood and severity). According to the results of the present study, the reliability and validity of the Persian version of CCS were acceptable. © 2018 Tehran University of Medical Sciences

UM ESTUDO DO TOC SOB A ÓTICA DA ANÁLISE DO COMPORTAMENTO A PARTIR DAS VARIÁVEIS DE CONTROLE DOS TRÊS NÍVEIS DE SELEÇÃO POR CONSEQUÊNCIAS: FILOGENÉTICO, ONTOGENÉTICO E CULTURAL

Obsessive-Compulsive Disorder (OCD) remains a significant clinical challenge, affecting the quality of life of millions of people worldwide. Additionally, understanding OCD through this theoretical lens provides valuable insights into the evolutionary origins, individual development, and sociocultural influences that shape the expression and maintenance of this complex disorder. Given this, the study aimed to analyze behavior and the three levels of the selection by consequences model regarding OCD, enabling a greater understanding of the disorder and seeking to contribute to scientific knowledge, benefiting the academic and clinical community. The study was characterized as qualitative and descriptive with an approach of reviewing academic literature. For this, the databases BVS, PubMed, and Google Scholar were used. The search results led to 44 studies that guided the discussion on the investigated topic. It is concluded that to fully understand OCD, an integrated approach incorporating phylogenetic, ontogenetic, and cultural aspects is essential. The disorder is shaped by evolutionary adaptive mechanisms linked to risk simulation, as well as genetic factors, individual experiences, and cultural influences. Effective treatment of OCD requires a thorough analysis of the reinforcement contingencies that maintain obsessive and compulsive behaviors, considering the interaction between the organism and the environment.El Trastorno Obsesivo-Compulsivo (TOC) sigue siendo un desafío clínico significativo, afectando la calidad de vida de millones de personas en todo el mundo. Además, comprender el TOC a través de esta lente teórica proporciona ideas valiosas sobre los orígenes evolutivos, el desarrollo individual y las influencias socioculturales que moldean la expresión y el mantenimiento de este trastorno complejo. Dado esto, el estudio tuvo como objetivo analizar el comportamiento y los tres niveles del modelo de selección por consecuencias en relación con el TOC, lo que permite una mayor comprensión del trastorno y busca contribuir al conocimiento científico, beneficiando a la comunidad académica y clínica. El estudio se caracterizó como cualitativo y descriptivo con un enfoque de revisión de la literatura académica. Para ello, se utilizaron las bases de datos BVS, PubMed y Google Scholar. Los resultados de la búsqueda llevaron a 44 estudios que orientaron el debate sobre el tema investigado. Se concluye que para comprender completamente el TOC, es esencial un enfoque integrado que incorpore aspectos filogenéticos, ontogenéticos y culturales. El trastorno está moldeado por mecanismos adaptativos evolutivos vinculados a la simulación de riesgos, así como a factores genéticos, experiencias individuales e influencias culturales. El tratamiento efectivo del TOC requiere un análisis exhaustivo de las contingencias de refuerzo que mantienen los comportamientos obsesivos y compulsivos, considerando la interacción entre el organismo y el ambiente.O Transtorno Obsessivo-Compulsivo (TOC) continua a ser um desafio clínico significativo, afetando a qualidade de vida de milhões de pessoas em todo o mundo. Além disso, a compreensão do TOC através dessa lente teórica fornecer insights valiosos sobre as origens evolutivas, o desenvolvimento individual e as influências socioculturais que moldam a expressão e a manutenção desse transtorno complexo. Diante do exposto, o estudo teve como objetivo analisar o comportamento e os três níveis do modelo de seleção por consequências em relação ao TOC possibilitando um maior conhecimento sobre o transtorno e buscando contribuir com o conhecimento científico, beneficiando a comunidade acadêmica e clínica. O estudo se caracterizou como qualitativo e descritivo com abordagem de revisão da literatura acadêmica. Para isso se utilizaram as bases de dados BVS, PubMed e Google Scholar. O resultados das busca levaram a 44 estudos que nortearam o debate acerca do tema investigado. Conclui-se que para se compreender plenamente o TOC, é essencial uma abordagem integrada que incorpore aspectos filogenéticos, ontogenéticos e culturais. O transtorno é moldado por mecanismos adaptativos evolutivos ligados à simulação de riscos, além de fatores genéticos, experiências individuais e influências culturais. O tratamento eficaz do TOC requer uma análise minuciosa das contingências de reforçamento que mantêm os comportamentos obsessivos e compulsivos, considerando a interação entre o organismo e o ambiente.O Transtorno Obsessivo-Compulsivo (TOC) continua a ser um desafio clínico significativo, afetando a qualidade de vida de milhões de pessoas em todo o mundo. Além disso, a compreensão do TOC através dessa lente teórica fornecer insights valiosos sobre as origens evolutivas, o desenvolvimento individual e as influências socioculturais que moldam a expressão e a manutenção desse transtorno complexo. Diante do exposto, o estudo teve como objetivo analisar o comportamento e os três níveis do modelo de seleção por consequências em relação ao TOC possibilitando um maior conhecimento sobre o transtorno e buscando contribuir com o conhecimento científico, beneficiando a comunidade acadêmica e clínica. O estudo se caracterizou como qualitativo e descritivo com abordagem de revisão da literatura acadêmica. Para isso se utilizaram as bases de dados BVS, PubMed e Google Scholar. O resultados das busca levaram a 44 estudos que nortearam o debate acerca do tema investigado. Conclui-se que para se compreender plenamente o TOC, é essencial uma abordagem integrada que incorpore aspectos filogenéticos, ontogenéticos e culturais. O transtorno é moldado por mecanismos adaptativos evolutivos ligados à simulação de riscos, além de fatores genéticos, experiências individuais e influências culturais. O tratamento eficaz do TOC requer uma análise minuciosa das contingências de reforçamento que mantêm os comportamentos obsessivos e compulsivos, considerando a interação entre o organismo e o ambiente

Soziale Prozesse und Psychische Störung: – drei klinische Open-Science-Studien zu Emotionsregulation, Social Mind und Mimikry

Psychische Störungen beinhalten einerseits Störungen der Emotionsregulation und des Verhaltens, andererseits bedeutsames Leiden oder Einschränkungen in den sozialen Beziehungen. In dieser Arbeit wird die Verbindung zwischen diesen beiden Aspekten untersucht. In einer Metaanalyse (Studie 1) werden die Zusammenhänge zwischen (mal)adaptiver Emotionsregulation und den verschiedenen Facetten des Social Mind (Theory of Mind, affektive Empathie, empathischer Stress und Mitgefühl) genauer betrachtet. Ein besonderes Augenmerk wird danach auf die Zwangsstörung gelegt, als ein Beispiel für eine psychische Störung mit großem Effekt auf die sozialen Beziehungen. Mithilfe von Selbstberichten und des EmpaToms, eine videobasierte Aufgabe, wird die Ausprägung der Social Mind-Facetten zwischen Personen mit einer diagnostizierten Zwangsstörung und einer nicht-klinischen Stichprobe verglichen (Studie 2). Die dritte Studie fokussiert auf die Interaktion zwischen Patient:innen mit Zwangsstörung und deren Therapeut:innen während der Therapie (Studie 3). Dabei beleuchten die Ergebnisse die gegenseitige Beeinflussung in der sozialen Mimikry von Patient:innen und Therapeut:innen und den Einfluss der Mimikry auf die therapeutische Allianz.:1. Einleitung 1.1. Aufbau der Arbeit 1.2. Social Mind und Emotionsregulation 1.3. Soziale Beeinträchtigungen bei Zwangsstörungen 2. Methode 3. Studien 3.1. Studie 1: A Meta-Analysis of the Relationship Between Emotion Regulation and Different Facets of the Social Mind 3.2. Studie 2: Empathy, Compassion and Theory of Mind in Obsessive-Compulsive Disorder 3.3. Studie 3: Mimicry in Psychotherapy – an actor partner model of therapists’ and patients’ non-verbal behavior and its effects on the working alliance 4. Diskussion 4.1. Metaanalyse: Emotionsregulation und Social Mind 4.2. Social Mind und Zwangsstörung 4.3. Mimikry und Zwangsstörung 4.4. Praktische Implikationen der Arbeit 4.5. Limitationen der drei Studien 4.6. Über das Konzept der Empathie 5. Zusammenfassun

Childhood maltreatment as a transdiagnostic risk factor for psychopathology

Over the last decades, childhood maltreatment has emerged as a major risk factor for the development and maintenance of transdiagnostic psychopathology. Notably, higher prevalence rates of maltreatment have been found for nearly all mental disorders, with particularly high numbers for post-traumatic stress disorder, depression, borderline personality disorder and anxiety disorders. Furthermore, childhood maltreatment has been associated with an earlier onset of mental disorders, a more severe and chronic course of disease as well as reduced rates of psychological treatment benefit. However, the pathways that underlie this relationship are still unknown. It has been shown that various factors, for example biological alterations, play a role in the relationship between childhood maltreatment and mental disorders. Research investigating the influence of psychological factors, such as emotional reactivity and emotional regulation, attachment or post-traumatic stress symptoms is rare. These investigations are highly relevant in order to identify potential targets for psychological interventions. First approaches in this line of research examine specific transdiagnostic treatments for early traumatization, such as Imagery Rescripting. However, as childhood maltreatment is suspected to be associated with a broad array of mental disorders, it might not be explained by a single underlying mechanism. Instead, multiple pathways are probable to mediate the relationship between childhood maltreatment and transdiagnostic psychopathology. Therefore, the major aim of this thesis is to make a first step in filling this research gap by investigating the underlying psychological mechanisms between childhood maltreatment and psychopathology in clinical studies. Studies I and II were conducted with a clinical sample (N= 69) of patients with obsessive compulsive disorder (OCD). Preliminary research, though limited by small sample sizes and inconsistent findings, showed that childhood maltreatment might play a role in OCD. In order to replicate and expand on these findings we aimed to examine the association of childhood maltreatment and OCD more closely. Study I primarily examined the subtypes of childhood maltreatment influencing OCD and additionally the impact of childhood maltreatment on the success of psychological OCD treatment (immediately following treatment and at 6 months post). We found three main results: First, increased prevalence rates of childhood maltreatment among our OCD patient sample in comparison to a general German population sample. Second, childhood maltreatment severity was related to greater OCD symptom severity, with the most robust relationship for the maltreatment subtype of emotional abuse. Third, individuals with higher levels of childhood maltreatment reported greater OCD symptoms at pre-treatment, post-treatment, and 6 months after their inpatient stay, compared to patients without maltreatment experiences. However, in contradiction of our hypothesis, childhood maltreatment did not influenced treatment benefit. Based on the findings, study II aimed to examine the underlying mechanisms of the detected association between childhood maltreatment and OCD symptoms. Potential mediating factors were chosen based on the following criteria: (a) evidence for association with childhood maltreatment, (b) evidence for association with OCD, and (c) existing plausible theoretical explanation for this mediator as an underlying mechanism. Therefore, we predicted that, emotion regulation difficulties, rumination, an insecure attachment style, dissociation, and post-traumatic stress symptoms are potential mediators between the association of childhood maltreatment and OCD symptom severity. In line with our hypotheses, these factors all mediated the relationship between childhood maltreatment and OCD symptom severity. However, regarding insecure attachment styles, the subtype of avoidant attachment was not linked to either childhood maltreatment or OCD symptom severity, suggesting that in OCD an anxious attachment is more prominent. Study III investigated the specific role of emotional reactivity as an underlying mechanism between childhood maltreatment and major depression in a clinical sample of patients with major depression (N= 69). Whereas in the literature for major depression the findings regarding heightened emotional reactivity are inconsistent, childhood maltreatment was widely associated with increased emotional reactivity. We therefore hypothesized that the severity of childhood maltreatment is related to higher emotional reactivity among depressive patients. Hence, self-reported and physiological emotional reactivity was measured while presenting audio recordings with neutral, negative and individualized childhood trauma-related scripts (so called script imagery method). In line with our hypothesis, depressive patients with higher levels of childhood maltreatment reported heightened emotional reactivity to the childhood trauma-related script and the negative script compared to the neutral script. In particular, they rated the negative script as more aversive and distressing. Additionally, they showed more re-experiencing and dissociation experiences in response to the negative script. Equally, the trauma-related script was perceived as more aversive and distressing. Furthermore, it resulted in greater levels of arousal and showed more avoidance as an emotional regulation strategy. In contrast to our hypothesis, no effect of childhood maltreatment on physiological responsiveness emerged. Overall, there is a growing body of literature showing that childhood maltreatment is a transdiagnostic risk factor for various mental disorders. However, few researchers have addressed the question of how this early vulnerability to psychopathology develops and persists. This thesis aimed to expand on current knowledge of the underlying pathways of the relationship between childhood maltreatment and psychopathology in two different mental disorders. The study findings presented in this thesis provide first evidence that heightened emotional reactivity (but not psychophysiological reactivity) and difficulties in emotion regulation, together with rumination might play a role. Moreover, post-traumatic stress symptoms, even those deemed subclinical, such as hyperarousal, avoidance and dissociative symptoms might be mediating factors between childhood maltreatment and transdiagnostic psychopathology. Since we found indications that re-experience might also play a role in mediating this relationship, future work will concentrate on exploring this factor in more detail. Additionally, further work is needed to investigate the cause of high divergence between self-report emotional reactivity and psychophysiological reactivity. From a methodological perspective, problems in assessing childhood maltreatment retrospectively with the childhood trauma questionnaire will be discussed. Moreover, implications for a theoretical transdiagnostic model and methodological approaches, as well as directions for future research on the underlying pathways of childhood maltreatment and psychopathology are outlined

An investigation of episodic future thinking, episodic foresight and prospective memory in children with Autism Spectrum Disorder

Background and Objectives: The overall objective of the current thesis was to investigate three forms of prospection in children with autism spectrum disorder (ASD), namely episodic future thinking, episodic foresight and prospective memory (PM), using three empirical studies. While few past studies have found ASD-related impairments in episodic future thinking, there is limited understanding of the mechanisms that might underpin these impairments in this clinical group. The aim of the first empirical study was therefore to investigate whether difficulties in two potential cognitive mechanisms, specifically scene construction and self-projection through time, might contribute to episodic future thinking deficits in children with ASD. In addition, no studies to date have examined the practical application of episodic future thinking, which involves taking steps in the present in light of imaginations of the future (referred to as episodic foresight in the current thesis), in individuals with ASD. Thus, the second empirical study aimed to investigate whether episodic foresight might be compromised in children with ASD, and possible cognitive factors that might underpin any identified episodic foresight deficits. Furthermore, while time-based PM has consistently been shown to be impaired in ASD, findings on event-based PM have been mixed in the literature. The cognitive contributors to impairments in PM also remain unclear. Hence, the aim of the third empirical study was to investigate event-based and time-based PM, as well as their potential contributing factors, in children with ASD. Lastly, given the importance of episodic foresight and PM on daily functioning argued in the literature, the current thesis also explored the relationships between these forms of prospection and functional capacity in children with ASD. Method and Results: Children with high-functioning ASD (i.e., IQ > 80) aged 8 to 12 years and age- and IQ-matched healthy controls were recruited for the current research project. Study 1 (n = 37 ASD, 60 controls) showed that impairments in episodic future thinking were linked to difficulties in scene construction, rather than self-projection through time. In addition, Study 2 (n = 40 ASD, 55 controls) provided novel evidence of an intact capacity to take appropriate steps in the present in anticipation of potential future problems in the ASD group. However, children with the disorder demonstrated an impaired capacity to subsequently implement actions at specific future points that allowed successful problem resolutions, therefore result in a failure in episodic foresight. The impairments in implementing actions at appropriate future points were not attributable to retrospective memory or executive functioning deficits. Study 3 (n = 32 ASD, 42 controls) revealed pervasive deficits in both event-based and time-based PM in children with ASD, and indicated that these deficits were related to difficulties in executive functioning and retrospective memory for PM task content. Finally, episodic foresight and PM were not found to be associated with functional capacity in the ASD group. Conclusions: The current thesis provided novel insights into the unique profile of impairments across different forms of prospection in children with ASD. Further investigations will be needed to clarify how and why specific impairments in these forms of prospection are apparent in children with ASD, specifically whether these impairments may be attributable to common underlying deficits. Future research in this area will be beneficial in contributing to the development of targeted interventions that aim to improve daily functioning in this clinical population

Telepsychotherapy for the Treatment of Trichotillomania: A Randomized Controlled Trial

Trichotillomania is defined as recurrent pulling of one’s hair that results in distress and negative effects on general functioning and quality of life. Estimates of trichotillomania lifetime prevalence generally range from approximately 1% to 3% and it is likely as common as disorders such as obsessive-compulsive disorder and agoraphobia. Yet, quality treatment for trichotillomania is often difficult to find as many mental health professionals are uninformed about the disorder and its treatment. Moreover, mental health services in general are inaccessible to many with estimates suggesting that 96.5 million people do not have access to adequate services. The use of telepsychology has been an effective method for disseminating treatment services for a variety of mental health conditions. However, no research has examined the effectiveness of telepsychology to treat trichotillomania. The current study reports the results of a randomized clinical trial of Acceptance and Commitment Therapy Enhanced Behavior Therapy for the treatment of trichotillomania delivered by way of telepsychology. The study compared an active treatment condition (n = 12) to a waitlist control condition (n = 10). Results showed significant reductions in hair pulling severity from pre- to post-treatment compared to the waitlist condition. Participants in the waitlist condition received the same treatment as participants in the treatment condition following the waitlist period. All participants were then combined to examine overall treatment effects from pre-treatment to a 12-week follow-up. The effect of treatment on hair pulling severity was still significant at follow-up, however the effect was not as strong as at post-treatment. Conversely, the effect on quality of life was maintained and even increased following post-treatment. Additional measures of psychological flexibility, perceived shame, and valued action also saw significant changes from pre-treatment to follow-up. The findings demonstrate that telepsychology is a viable option to disseminate treatment for trichotillomania. Implications, limitations, and future research directions are discussed

Clinical and genetic investigation of the epsilon-sarcoglycan complex in neurologic and psychiatric disease

Myoclonus Dystonia Syndrome is a childhood onset hyperkinetic movement disorder characterised by alcohol responsive upper body myoclonus and dystonia. A proportion of cases are due to mutations in the maternally imprinted SGCE gene, which encodes the transmembrane epsilon-sarcoglycan protein. Previous studies suggest an increased rate of psychiatric disorders in those with SGCE mutations. This study aimed to establish a cohort of myoclonus dystonia syndrome patients, identify the rate and type of SGCE mutations, determine differences in motor characteristics between mutation positive and negative cases and whether psychiatric disorders form part of the disease phenotype. Eighty-nine probands with clinically suspected MDS were recruited. Information regarding onset and distribution of motor symptoms was collected via systematic questionnaires and video taped examination. SGCE was analysed using direct sequencing and for copy number variants. Psychiatric symptoms were assessed using systematic and standardised questionnaires and compared to a disability-matched, alcohol responsive tremor control group. Nineteen (21%) probands had an SGCE mutation. All had evidence of upper body predominant myoclonus and dystonia during their disease course. Five had contiguous gene deletions ranging from 0.7 to 2.3Mb in size with distinctive clinical features. Recruitment of family members increased the affected SGCE mutation positive group to 27 of whom 21 (77%) had psychiatric symptoms. Obsessive-Compulsive Disorder was eight times more likely (p<0.001) in mutation positive cases, compulsivity being the predominant feature (p<0.001). Generalized Anxiety Disorder (p=0.003) and alcohol dependence (p=0.02) were five times more likely in cases than tremor controls. Overall, SGCE mutations are associated with a narrow clinical and specific psychiatric phenotype. The presence of myoclonus, dystonia, age at onset ≤10 years and a positive family history of the disorder are the strongest predictors of an SGCE mutation. SGCE mutations are likely to have a pleiotropic effect in causing both motor and specific psychiatric symptoms