Is there an evidence-based number of sessions in outpatient psychotherapy? – A comparison of naturalistic conditions across countries

Deciding on the number of psychotherapy sessions to satisfactorily treat a patient is a vital clinical as well as economic issue in most mental health systems worldwide. The length of outpatient psychotherapy in naturalistic conditions ranges from a single session to hundreds of sessions [1]. In randomized clinical trials, the number of sessions is typically fixed to deliver manualized treatments and to control for dosage effects (e.g., in a 16-session format [2]). Using data from Routine Outcome Monitoring studies [3, 4], we investigated whether the treatments under naturalistic conditions were fixed to a particular number of sessions or not (H1), whether naturalistic conditions tended to include unusually long treatments (e.g., >100 sessions) (H2), and how the observed number of sessions was distributed across countries (H3)

The Development and Validation of the Thai-Translated Irrational Performance Beliefs Inventory (T-iPBI)

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. One of the most commonly employed cognitive-behavioural approaches to psychotherapy is rational-emotive behaviour therapy, but researchers have been troubled by some of the limitations of irrational beliefs psychometrics. As a result, Turner et al. (Eur J Psychol Assess 34:174–180, 2018a. https://doi.org/10.1027/1015-5759/a000314) developed the Irrational Performance Beliefs Inventory (iPBI), a novel measure of irrational beliefs for use within performance domains. However, the linguistic and cross-cultural adaptation of the iPBI into other languages is necessary for its multinational and multicultural use. The purpose of this paper is to develop the Thai-translated version of the iPBI (T-iPBI) and examine the validity and reliability of the T-iPBI. Data retrieved from 166 participants were analysed using SPSS and AMOS software packages. Thirty-three participants completed two follow-up T-iPBI measurements (1- and 3-week repeat assessment). After the linguistic and cross-cultural adaptation processes, the T-iPBI demonstrated excellent levels of reliability, with internal consistency and test–retest reliability, as well as construct, concurrent, and predictive validity. The current findings indicate that the 20-item T-iPBI can be used as a self-assessment instrument to evaluate individual’s irrational performance beliefs in a Thai population. We also highlight the implications of this study and suggest a variety of future research directions that stem from the results

Is there a sleeper effect of exposure-based vs. cognitive-only intervention for anxiety disorders? A longitudinal multilevel meta-analysis

There is a longstanding debate in the cognitive behavioral literature whether exposure-based methods produce more sustainable outcomes relative to cognitive methods or vice versa. This debate concerns particularly the time after treatment termination (at follow-up assessments), also referred to as the sleeper effect. Therefore, the aim of the current meta-analysis was to examine the enduring efficacy of Exposure Therapy (ET) in comparison to Cognitive Therapy (CT) from treatment termination to follow-up in anxiety disorders. Available literature also allowed for the assessment of their long-term additive benefits relative to ET only. Traditional random effects analyses with restricted maximum likelihood estimators and multilevel longitudinal analyses were conducted on 39 randomized controlled trials (N = 1878). Traditional analyses revealed no differential efficacy at post-treatment or follow-up. Similarly, the multilevel longitudinal analyses identified no differential growth in efficacy from treatment termination to follow-up. The majority of the variables investigated did not moderate the results. However, there was evidence suggesting that CT was superior to ET when treatment was delivered individually, while ET was superior to CT when delivered as group therapy. Overall, the findings did not validate a number of assumptions, such as the existence of a sleeper effect. Several strengths and limitations are further discussed in the paper

The working alliance in manualized CBT for generalized anxiety disorder Does it lead to change and does the effect vary depending on manual implementation flexibility?

Objective: The investigation of session-to-session effects of working alliance on symptoms and coping experiences in patients diagnosed with GAD. Additionally, investigating these effects dependent on whether therapists are primed to work with patients strength (resource priming) or to adhere to the treatment manual (adherence priming). Method: Data was drawn from a randomized controlled trial in which 57 patient were randomly assigned to either the resource priming condition or the adherence priming condition. Within- and between patient associations were disentangled using dynamic structural equation modeling. Results: The total score of the working alliance as well as all its overlapping components (i.e., goal agreement, task consensus, bond) showed significant within-patient effects on next session coping experiences. More specifically, better alliance scores in one session were followed by more coping experiences in the subsequent session. With regard to anxiety symptoms, an association was found only with the working alliance total score as well as for the bonds component, but not for the goals and task components of the working alliance. The priming condition (resource priming vs adherence priming) had no influence on the within-patient alliance-outcome association. Between-patient alliance associations were only present with coping experiences, but not with anxiety symptoms. Conclusion: The findings provide further empirical evidence for the hypothesis that the working alliance may be a robust facilitative factor for change in CBT treatments for GAD which evolves irrespective of the strictness with which therapists adhere to the treatment manual.</p

The working alliance in manualized CBT for generalized anxiety disorder Does it lead to change and does the effect vary depending on manual implementation flexibility?

Objective: The investigation of session-to-session effects of working alliance on symptoms and coping experiences in patients diagnosed with GAD. Additionally, investigating these effects dependent on whether therapists are primed to work with patients strength (resource priming) or to adhere to the treatment manual (adherence priming). Method: Data was drawn from a randomized controlled trial in which 57 patient were randomly assigned to either the resource priming condition or the adherence priming condition. Within- and between patient associations were disentangled using dynamic structural equation modeling. Results: The total score of the working alliance as well as all its overlapping components (i.e., goal agreement, task consensus, bond) showed significant within-patient effects on next session coping experiences. More specifically, better alliance scores in one session were followed by more coping experiences in the subsequent session. With regard to anxiety symptoms, an association was found only with the working alliance total score as well as for the bonds component, but not for the goals and task components of the working alliance. The priming condition (resource priming vs adherence priming) had no influence on the within-patient alliance-outcome association. Between-patient alliance associations were only present with coping experiences, but not with anxiety symptoms. Conclusion: The findings provide further empirical evidence for the hypothesis that the working alliance may be a robust facilitative factor for change in CBT treatments for GAD which evolves irrespective of the strictness with which therapists adhere to the treatment manual.</p

Supplementary Material for: Irrational Beliefs and Psychological Distress: A Meta-Analysis

<b><i>Background:</i></b> Since the cognitive revolution of the early 1950s, cognitions have been discussed as central components in the understanding and treatment of mental illnesses. Even though there is an extensive literature on the association between therapy-related cognitions such as irrational beliefs and psychological distress over the past 60 years, there is little meta-analytical knowledge about the nature of this association. <b><i>Methods:</i></b> The relationship between irrational beliefs and distress was examined based on a systematic review that included 100 independent samples, gathered in 83 primary studies, using a random-effect model. The overall effects as well as potential moderators were examined: (a) distress measure, (b) irrational belief measure, (c) irrational belief type, (d) method of assessment of distress, (e) nature of irrational beliefs, (f) time lag between irrational beliefs and distress assessment, (g) nature of stressful events, (h) sample characteristics (i.e. age, gender, income, and educational, marital, occupational and clinical status), (i) developer/validator status of the author(s), and (k) publication year and country. <b><i>Results:</i></b> Overall, irrational beliefs were positively associated with various types of distress, such as general distress, anxiety, depression, anger, and guilt (omnibus: r = 0.38). The following variables were significant moderators of the relationship between the intensity of irrational beliefs and the level of distress: irrational belief measure and type, stressful event, age, educational and clinical status, and developer/validator status of the author. <b><i>Conclusions:</i></b> Irrational beliefs and distress are moderately connected to each other; this relationship remains significant even after controlling for several potential covariates

The Relative Efficacy of Bona Fide Cognitive Behavioral Therapy and Applied Relaxation for Generalized Anxiety Disorder at Follow-up: A Longitudinal Multilevel Meta-Analysis

Objective: This meta-analysis examined the relative efficacy of bona fide psychotherapy conditions in generalized anxiety disorder (GAD) from posttreatment to follow-up in adults. Methods: Omnibus tests of relative efficacy across bona fide psychotherapies for primary and secondary outcomes were conducted. Longitudinal multilevel subgroup analyses investigated, (a) applied relaxation versus cognitive behavioral therapy (CBT) without applied relaxation and (b) well-established CBT versus augmented integrative CBT. Results: In total, 54 repeated effect sizes nested in 23 studies were included in this meta-analysis. Omnibus test of relative efficacy indicated no significant differences among the bona fide psychotherapy contrasts in primary and some differences in secondary outcomes. When contrasting applied relaxation with CBT without applied relaxation, negligible relative efficacy differences were found at each assessment time. There were small efficacy differences in favor of augmented integrative CBT in comparison to wellestablished CBT. Conclusion: Small relative efficacy differences were found between bona fide psychotherapies in GAD.Fil: Flückiger, Christoph. Universitat Zurich; SuizaFil: Carratta, Katja. Universitat Zurich; SuizaFil: Del Re, A. C.. Universitat Zurich; SuizaFil: Probst, Greta. Universitat Zurich; SuizaFil: Vîslă, Andreea. Universitat Zurich; SuizaFil: Gómez Penedo, Juan Martín. Universidad de Buenos Aires; Argentina. Universitat Zurich; Suiza. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Wampold, Bruce E.. University of Wisconsin; Estados Unido

Considerations of how to conduct meta-analyses in psychological interventions

Clinical or methodological significance of this article: Meta-analysis is a powerful tool for resolving conflicting conjectures or findings while also providing a critical overview of a scientific area