Therapeutic Alliance and Treatment Expectations: Predicting Outcomes in Exposure Treatments for Specific Phobia

Background Exposure-based treatments have demonstrated some of the largest effect sizes in the treatment of specific phobias (SP). There are different ways of delivering exposure such as Augmented Reality Exposure which has become an interesting alternative to In Vivo Exposure for treating SP. The present study aimed to investigate the therapeutic alliance and treatment expectations as possible predictors of treatment outcomes in these two exposure treatment conditions. Methods Participants were 63 adults who met diagnostic criteria for the diagnosis of a SP of cockroaches or spiders (animal subtype). Patients were randomized to receive a one-session treatment of either In Vivo Exposure (N = 31) or Augmented Reality Exposure (N = 32). The assessment protocol included diagnostic, as well as primary-, and secondary outcome measures. Materials included the Behavioral Avoidance Test for measuring symptoms and outcomes, the Expectations and Satisfaction Questionnaire, and the Working Alliance Inventory. We ran multilevel analyses for the study of predictors controlling for the treatment effect conditions. Results Results showed a significant effect of expectations on treatment outcomes (specifically avoidance and beliefs scores). The therapeutic alliance did not have a significant effect on treatment outcome. Patients reduced their symptoms of phobia. Conclusion These results empirically support treatment expectations as a relevant predictor of change in exposure treatments for SP

Propiedades psicométricas del Hopkins Symptom Checklist (HSCL-11) en Argentina: Un instrumento para monitoreo y feedback en psicoterapia

We failed to find brief instruments validated in Argentina to explore and monitor psychological symptoms from psychotherapy patients. This paper presents the Argentinian adaptation of the Hopkins Symptoms Checklist (HSCL-11) and analyzes its psychometric properties. A sample of 356 participants completed the HSCL-11 adaptation, along with other measures of depression, anxiety, and well-being. We analyzed Cronbach’s alpha and item-total correlations adjusted. We ran confirmatory factor analysis, correlations among the measures, and  examined differences in HSCL-11 between subjects who were psychotherapy patients and those who were not. We found evidence of adequate internal consistency and item homogeneity, as well as construct validity, concurrent validity, and criterion validity. Results showed evidence of reliability and validity for the HSCL-11 Argentinian adaptation, suggesting that it might represent a meaningful resource for the evaluation and treatment of mental disorders in Argentina.No se han encontrado instrumentos breves válidos en Argentina para monitorear sintomatología psicológica en psicoterapia. Este trabajo presenta la adaptación argentina del Hopkins Symptoms Checklist (HSCL-11) y estudia sus propiedades psicométricas. Una muestra de 356 participantes completó la adaptación del HSCL-11 junto con medidas de depresión, ansiedad y bienestar. Se computaron el coeficiente alfa de Cronbach y correlaciones ítem-total corregidas. Se realizó un análisis factorial confirmatorio, se estudiaron sus correlaciones con las otras medidas y se analizaron las diferencias en HSCL-11 entre pacientes y no pacientes de terapia. Se observaron evidencias de adecuada consistencia interna y homogeneidad de ítems, así como también de validez de constructo, validez concurrente y validez de criterio. Los resultados mostraron evidencias deconfiabilidad y validez de la versión argentina del HSCL-11, sugiriendo que podría representar un instrumento valioso para la evaluación y el tratamiento de patologías mentales en el país

Randomized controlled phase 2 trial of hydroxychloroquine in childhood interstitial lung disease

Background No results of controlled trials are available for any of the few treatments offered to children with interstitial lung diseases (chILD). We evaluated hydroxychloroquine (HCQ) in a phase 2, prospective, multicentre, 1:1-randomized, double-blind, placebo-controlled, parallel-group/crossover trial. HCQ (START arm) or placebo were given for 4 weeks. Then all subjects received HCQ for another 4 weeks. In the STOP arm subjects already taking HCQ were randomized to 12 weeks of HCQ or placebo (= withdrawal of HCQ). Then all subjects stopped treatment and were observed for another 12 weeks. Results 26 subjects were included in the START arm, 9 in the STOP arm, of these four subjects participated in both arms. The primary endpoint, presence or absence of a response to treatment, assessed as oxygenation (calculated from a change in transcutaneous O 2 -saturation of ≥ 5%, respiratory rate ≥ 20% or level of respiratory support), did not differ between placebo and HCQ groups. Secondary endpoints including change of O 2 -saturation ≥ 3%, health related quality of life, pulmonary function and 6-min-walk-test distance, were not different between groups. Finally combining all placebo and all HCQ treatment periods did not identify significant treatment effects. Overall effect sizes were small. HCQ was well tolerated, adverse events were not different between placebo and HCQ. Conclusions Acknowledging important shortcomings of the study, including a small study population, the treatment duration, lack of outcomes like lung function testing below age of 6 years, the small effect size of HCQ treatment observed requires careful reassessments of prescriptions in everyday practice (EudraCT-Nr.: 2013-003714-40, www.clinicaltrialsregister.eu , registered 02.07.2013)

Negative mood regulation as a mechanism of change in cognitive therapy for depression

The present study investigates the effects of negative mood regulation expectancies (NMRE) on symptom severity of depression in two cognitive therapies for depression. The sample included the first 146 consecutively recruited patients from a randomized controlled trial. Patients received 22 sessions of either cognitive behavioral therapy (CBT) or exposure based cognitive therapy (EBCT). They completed the Beck Depression Inventory and Negative Mood Regulation Scale at baseline and treatment termination, as well as after sessions seven and 14. Multilevel modeling was applied. We found a significant between-patient effect of NMRE on symptom severity of depression, when NMRE within-patient effects were set to random. There was no significant interactive effect of the between-patient NMRE with type of treatment. However, a significant moderation effect of the within-patient NMRE effect by treatment condition on depression severity was detected, with patients receiving CBT benefiting more from improvements in NMRE. Together, these results empirically support NMRE as a relevant mechanism of change in cognitive therapy for depression

Negative Mood Regulation as a Mechanism of Change in Cognitive Therapy for Depression

The present study investigates the effects of negative mood regulation expectancies (NMRE) on symptom severity of depression in 2 cognitive therapies for depression. The sample included the first 146 consecutively recruited patients from a randomized controlled trial. Patients received 22 sessions of either cognitive-behavioral therapy or exposure-based cognitive therapy. They completed the Beck Depression Inventory and Negative Mood Regulation Scale at baseline and treatment termination, as well as after Sessions 7 and 14. Multilevel modeling was applied. We found a significant betweenpatient effect of NMRE on symptom severity of depression, when NMRE within-patient effects were set to random. There was no significant interactive effect of the between-patient NMRE with type of treatment. However, a significant moderation effect of the within-patient NMRE effect by treatment condition on depression severity was detected, with patients receiving cognitive-behavioral therapy benefiting more from improvements in NMRE. Together, these results empirically support NMRE as a relevant mechanism of change in cognitive therapy for depression.Fil: Areas, Malenka Alejandra. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gómez Penedo, Juan Martín. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Alalú, Nicolás. Universidad de Buenos Aires; ArgentinaFil: Babl, Anna Margarete. University of Bern; SuizaFil: Roussos, Andres Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Holtforth, Martin. University of Bern; Suiz

Effects of patient–therapist interpersonal complementarity on alliance and outcome in cognitive–behavioral therapies for depression: Moving toward interpersonal responsiveness

This study analyzed patient–therapist in-session interpersonal complementarity effects on the therapeutic alliance and depression severity during the initial and working phase of cognitive–behavioral therapy for depression. It also explored whether patients’ interpersonal problems moderate those complementarity effects. We drew on a sample of 90 dyads derived from a randomized controlled trial of two cognitive–behavioral therapies for depression. Using an observer-based measure, we assessed patients’ and therapists’ interpersonal behavior in Sessions 1, 5, 9, and 13 and computed their complementarity regarding interpersonal affiliation (i.e., correspondence) and dominance (i.e., reciprocity). Patients completed measures of interpersonal problems at baseline and session-by-session measures of depression severity and quality of the therapeutic alliance. Response surface analyses based on polynomial regressions showed that patient–therapist complementarity in higher affiliative behaviors was associated with a stronger alliance. Interpersonal problems regarding agency moderated the complementarity effects of the dominance dimensions on depression severity. Overly dominant patients benefited more from a nonreciprocal relationship in the dominance dimension, whereas submissive patients benefited more from complementarity in that dimension. Furthermore, interpersonal problems of communion significantly moderated the effects of complementarity in affiliative behaviors on both the alliance and outcome. These results suggest the relevance of both interpersonal correspondence and reciprocity for the psychotherapy process, informing clinical practice in terms of interpersonal responsiveness. The moderation effects of interpersonal problems provide preliminary evidence, which should be replicated in future research, to determine relevant markers indicating for whom a complementary approach would be beneficial in cognitive therapy for depression