Hasil untuk "Therapeutics. Psychotherapy"

C. Flückiger, A. D. Del Re, B. Wampold et al.

The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance–outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices.

Matthew W. Johnson, P. Hendricks, F. Barrett et al.

ABSTRACT The purpose of this paper is to provide an integrative review and offer novel insights regarding human research with classic psychedelics (classic hallucinogens), which are serotonin 2A receptor (5‐HT2AR) agonists such as lysergic acid diethylamide (LSD), mescaline, and psilocybin. Classic psychedelics have been administered as sacraments since ancient times. They were of prominent interest within psychiatry and neuroscience in the 1950s to 1960s, and during this time contributed to the emergence of the field of molecular neuroscience. Promising results were reported for treatment of both end‐of‐life psychological distress and addiction, and classic psychedelics served as tools for studying the neurobiological bases of psychological disorders. Moreover, classic psychedelics were shown to occasion mystical experiences, which are subjective experiences reported throughout different cultures and religions involving a strong sense of unity, among other characteristics. However, the recreational use of classic psychedelics and their association with the counterculture prompted an end to human research with classic psychedelics in the early 1970s. We provide the most comprehensive review of epidemiological studies of classic psychedelics to date. Notable among these are a number of studies that have suggested the possibility that nonmedical naturalistic (non‐laboratory) use of classic psychedelics is associated with positive mental health and prosocial outcomes, although it is clear that some individuals are harmed by classic psychedelics in non‐supervised settings. We then review recent therapeutic studies suggesting efficacy in treating psychological distress associated with life‐threatening diseases, treating depression, and treating nicotine and alcohol addictions. We also describe the construct of mystical experience, and provide a comprehensive review of modern studies investigating classic psychedelic‐occasioned mystical experiences and their consequences. These studies have shown classic psychedelics to fairly reliably occasion mystical experiences. Moreover, classic‐psychedelic‐occasioned mystical experiences are associated with improved psychological outcomes in both healthy volunteer and patient populations. Finally, we review neuroimaging studies that suggest neurobiological mechanisms of classic psychedelics. These studies have also broadened our understanding of the brain, the serotonin system, and the neurobiological basis of consciousness. Overall, these various lines of research suggest that classic psychedelics might hold strong potential as therapeutics, and as tools for experimentally investigating mystical experiences and behavioral‐brain function more generally.

J. Norcross, M. Lambert

This article introduces the journal issue devoted to the most recent iteration of evidence-based psychotherapy relationships and frames it within the work of the Third Interdivisional American Psychological Association Task Force on Evidence-Based Relationships and Responsiveness. The authors summarize the overarching purposes and processes of the Task Force and trace the devaluation of the therapy relationship in contemporary treatment guidelines and evidence-based practices. The article outlines the meta-analytic results of the subsequent 16 articles in the issue, each devoted to the link between a particular relationship element and treatment outcome. The expert consensus deemed 9 of the relationship elements as demonstrably effective, 7 as probably effective, and 1 as promising but with insufficient research to judge. What works—and what does not—in the therapy relationship is emphasized throughout. The limitations of the task force work are also addressed. The article closes with the Task Force’s formal conclusions and 28 recommendations. The authors conclude that decades of research evidence and clinical experience converge: The psychotherapy relationship makes substantial and consistent contributions to outcome independent of the type of treatment.

Mehrnoosh Sadat Shirvani, Jackie Crowley, Cher Peng et al.

As digital tools increasingly mediate mental health care, self-clone chatbots can offer a uniquely novel approach to intra-personal exploration and self-derived support. Trained to replicate users' conversational patterns, self-clones allow users to talk to themselves through their digital replicas. Despite the promises, these systems may carry risks around identity confusion, negative reinforcement, and blurred user agency. Through interviews with 16 mental health professionals and 6 general users, we aim to uncover tensions and design opportunities in this emerging space to guide responsible self-clone design. Our analysis produces a design framework organized around three priorities: (1) defining goals and grounding the approach in existing therapeutic models, (2) design dimensions including the self-clone persona and user-clone relationship dynamics, and (3) considerations for minimizing potential emotional and ethical harms. This framework contributes an interdisciplinary foundation for designing self-clone chatbots as AI-mediated self-interaction tools that are emotionally and ethically attuned in mental health contexts.

E. Fernandez, Yilma Woldgabreal, A. Day et al.

In-person psychotherapy (IPP) has a long and storied past but technology advances have ushered in a new era of video-delivered psychotherapy (VDP). In this meta-analysis, pre-post changes within VDP were evaluated as were outcome differences between VDP vs IPP or other comparison groups. A literature search identified k=56 within-group studies (N= 1681 participants) and 47 between-group studies (N=3564). The pre-post effect size of VDP was large and highly significant, g=+0.99 95% CI [0.67; 0.31]. VDP was significantly better in outcome than wait list controls (g=0.77) but negligible in difference from IPP. Within-groups heterogeneity of effect sizes was reduced after subgrouping studies by treatment target, of which anxiety, depression, and PTSD (each with k> 5) had effect sizes nearing 1.00. Disaggregating within-groups studies by therapy type, the effect size was 1.34 for CBT, and 0.66 for non-CBT. Adjusted for possible publication bias, the overall effect size of VDP within groups was g=0.54. In conclusion, substantial and significant improvement occurs from pre- to post-phases of VDP, this in turn differing negligibly from IPP treatment outcome. The VDP improvement is most pronounced when CBT is used, and when anxiety, depression, or PTSD are targeted, and it remains strong though attenuated by publication bias. Clinically, therapy is no less efficacious when delivered via videoconferencing than in-person, with efficacy most pronounced in CBT for affective disorders. Live psychotherapy by video emerges not only as a popular and convenient choice but also one that is now upheld by meta-analytic evidence.

Liying Wang, Ph. D., Daffodil Carrington et al.

Family caregivers often face substantial mental health challenges due to their multifaceted roles and limited resources. This study explored the potential of a large language model (LLM)-powered conversational agent to deliver evidence-based mental health support for caregivers, specifically Problem-Solving Therapy (PST) integrated with Motivational Interviewing (MI) and Behavioral Chain Analysis (BCA). A within-subject experiment was conducted with 28 caregivers interacting with four LLM configurations to evaluate empathy and therapeutic alliance. The best-performing models incorporated Few-Shot and Retrieval-Augmented Generation (RAG) prompting techniques, alongside clinician-curated examples. The models showed improved contextual understanding and personalized support, as reflected by qualitative responses and quantitative ratings on perceived empathy and therapeutic alliances. Participants valued the model's ability to validate emotions, explore unexpressed feelings, and provide actionable strategies. However, balancing thorough assessment with efficient advice delivery remains a challenge. This work highlights the potential of LLMs in delivering empathetic and tailored support for family caregivers.

Youngjae Yoo, Minuk Kim, Soyoung Kim et al.

Background: Despite the clinical effectiveness of digital interventions for young adults with depression, low engagement and adherence remain persistent challenges. Building a strong digital therapeutic alliance has been proposed to address these barriers. This study highlights the need for a conversational therapeutic companion agent (TCA)-based intervention design. Objective: This study aimed to develop a Wizard-of-Oz TCA-centered prototype integrating social-support-based ecological momentary assessment (EMA), ecological momentary intervention (EMI), behavioral activation, and gamification. We evaluated the six-week proof-of-concept efficacy of this intervention among young adults with depressive symptoms. Methods: Korean young adults aged 20--39 years with mild-to-moderate depressive symptoms (PHQ-9) were recruited online. The intervention group ($n = 29$) received a six-week TCA-based digital intervention, while the control group ($n = 29$), recruited four weeks later, continued their usual routines. The TCA guided four daily behavioral-activation tasks, three mood assessments, meditation, daily summaries, and weekly mission feedback. Both groups were assessed at baseline and at weeks 2, 4, and 6 using the BDI-II, GAD-7, and Q-LES-Q-SF. Results: Of 58 participants, 57 completed the study (one dropout in the intervention group). At week 6, the intervention group showed significantly greater reductions in depressive symptoms and improvements in quality of life than controls. Adherence was 78\% for EMA, 51\% for EMI, and 65\% for daily routines. Conclusions: The TCA-based digital intervention improved depressive symptoms and quality of life with adherence levels comparable to previous digital health interventions. Future studies should refine the TCA design and conduct larger-scale evaluations.

Soraya S. Anvari, Rina R. Wehbe

Large Language Models (LLMs) are increasingly deployed in mental health contexts, from structured therapeutic support tools to informal chat-based well-being assistants. While these systems increase accessibility, scalability, and personalization, their integration into mental health care brings privacy and safety challenges that have not been well-examined. Unlike traditional clinical interactions, LLM-mediated therapy often lacks a clear structure for what information is collected, how it is processed, and how it is stored or reused. Users without clinical guidance may over-disclose personal information, which is sometimes irrelevant to their presenting concern, due to misplaced trust, lack of awareness of data risks, or the conversational design of the system. This overexposure raises privacy concerns and also increases the potential for LLM bias, misinterpretation, and long-term data misuse. We propose a framework embedding Artificial Intelligence (AI) literacy interventions directly into mental health conversational systems, and outline a study plan to evaluate their impact on disclosure safety, trust, and user experience.

Kate Witteveen, Denis O'Hara

This study developed a brief measure of the psychosocial impact of attention-deficit/hyperactivity disorder (ADHD) and explored relationships between mentalisation, self-compassion, and the psychosocial impact of ADHD in adult women. The study hypothesised that lower mentalisation would correspond to higher psychosocial impact and that self-compassion would act as a mediator of this relationship. In Phase 1, a new measure, the ADHD Impact on Psychosocial Functioning (AIPF), was administered to a sample of women with a diagnosis of ADHD (N = 388), and a preliminary investigation of its psychometric properties was undertaken. Psychometric analyses provided preliminary support for the internal consistency and construct validity of a two-factor structure of the AIPF, and it was therefore retained for Phase 2. In Phase 2, the Mentalisation Scale, the Self-Compassion Scale—Short Form, and the AIPF were administered to an additional sample of women with ADHD (N = 89). Analyses revealed that self-mentalisation was significantly lower than other dimensions of mentalisation. As hypothesised, low self-mentalisation was associated with high psychosocial impact of ADHD, and this was fully mediated by self-compassion. These findings highlight the unique role of self-mentalisation as a predictor of negative psychosocial outcomes in women with ADHD and provide additional evidence of the protective role of self-compassion. Together, these findings suggest the potential benefits of therapeutic interventions focusing on the augmentation of self-mentalisation and self-compassion in women with ADHD. Limitations of the current study and recommendations for future research are discussed.

Catherine Joye Bruno

Con el análisis del mito fundador del culto del oso en la sociedad saami, que representa la feminización de ese ancestro primordial, y comparándolo con el mito freudiano del padre de la horda, se busca arrojar luz sobre la naturaleza de lo que es incorporado durante la comida caníbal y responder a las preguntas analíticas que esta mitología plantea a la incorporación primordial del padre en Freud y en Lacan. A diferencia del mito freudiano, la humanización nace de la unión de un oso y de una mujer, una unión que, para lograr este efecto, debe culminar en la muerte del oso. Es la intervención de una mujer al casarse con un animal lo que permite generar la humanidad con el nacimiento de un primer hijo que, justamente, porque no mata a su padre, deviene humano. 

Zbyněk Vybíral, B. Ogles, T. Řiháček et al.

ABSTRACT Objective: A considerable number of clients report adverse or unwanted effects of psychological treatments. This study aimed to synthesize the findings of qualitative studies focused on what clients perceive as negative experiences in psychotherapy. Method: A database search was conducted to find primary studies, and a qualitative meta-analysis was used to aggregate the findings on the kinds of negative experiences psychotherapy clients reported. Results: A total of 936 statements were extracted from 51 primary studies and categorized into 21 meta-categories, some of which were further divided into subcategories. These meta-categories covered clients’ experiences, which fell into four broad clusters: therapists’ misbehaviour, hindering aspects of the relationship, poor treatment fit, and negative impacts of treatment. Conclusion: Clients’ negative experiences of psychotherapy are a vast and heterogeneous area, the breadth of which is not captured by any single study. By synthesizing the findings of many primary studies, this meta-analysis represents the most comprehensive summary of these experiences to date.

Dana Atzil-Slonim, Christina S. Soma, Xinyao Zhang et al.

Abstract Objective: This paper highlights the facilitation of dyadic synchrony as a core psychotherapist skill that occurs at the non-verbal level and underlies many other therapeutic methods. We define dyadic synchrony, differentiate it from similar constructs, and provide an excerpt illustrating dyadic synchrony in a psychotherapy session. Method: We then present a systematic review of 17 studies that have examined the associations between dyadic synchrony and psychotherapy outcomes. We also conduct a meta-analysis of 8 studies that examined whether there is more synchrony between clients and therapists than would be expected by chance. Results: Weighted box score analysis revealed that the overall association of synchrony and proximal as well as distal outcomes was neutral to mildly positive. The results of the meta-analysis indicated that real client-therapist dyad pairs exhibited synchronized behavioral patterns to a much greater extent than a sample of randomly paired people who did not actually speak. Conclusion: Our discussion revolves around how synchrony can be facilitated in a beneficial way, as well as situations in which it may not be beneficial. We conclude with training implications and therapeutic practices.

J. Markowitz

Importance: Extensively researched, exposure-focused therapies have dominated the treatment of posttraumatic stress disorder (PTSD). No treatment benefits all patients. Interpersonal psychotherapy (IPT), a nonexposure, affect-focused treatment, has emerged over 2 decades as an alternative evidence-based PTSD intervention. Objective: This narrative review critically assesses IPT outcomes for PTSD. Time limited IPT focuses on affect toleration and the interpersonal consequences of trauma rather than on reconstructing the trauma narrative and exposure to traumatic cues. Evidence Review: The author searched the outcome literature on IPT for adults with syndromal PTSD and drew upon personal involvement in studies since 2001. Subsyndromal PTSD studies and 1 adolescent trial were excluded. Findings: Thirteen published studies of IPT targeted PTSD in individual and group formats for 592 civilians (n = 8, 6 randomized controlled trials [RCTs]) and 187 military veterans (n = 5, 1 RCT). Some trials had methodological limitations. IPT surpassed outcomes of waiting lists and other weak controls and was noninferior to evidence-based PTSD treatments including Prolonged Exposure (n = 2) and sertraline (n = 1). Depression and other outcomes improved. The RCTs demonstrate IPT efficacy for PTSD and allow preliminary exploration of outcome mediators and moderators and differential therapeutics. Conclusion: While the number of studies remains limited, research by multiple investigators in differing populations supports the efficacy of IPT as a non trauma-focused PTSD treatment and justifies its inclusion in PTSD treatment guidelines. More research is necessary to determine how IPT compares to exposure-focused treatments in patient preference, attrition, and response for PTSD comorbid with major depression or due to sexual trauma.

Hector Y. Adames, Nayeli Y. Chavez-Dueñas, Jioni A. Lewis et al.

There is a large body of research on the importance of addressing culture in psychotherapy. However, less is known about providing critically conscious and racially affirmative therapy for Black, Indigenous, and People of Color (BIPOC) clients in the context of ongoing systemic racism and racism-related stress and trauma, especially in the sociopolitical context of the United States. This article introduces and illustrates the Keeping Radical Healing in Mind Therapeutic Approach using a sample therapy session. To contextualize the therapeutic approach, we outline the need for antiracist and liberatory approaches to psychotherapy and describe in detail the Psychology of Radical Healing theoretical framework. The clinical stance that underpins the Keeping Radical Healing in Mind Therapeutic Approach includes helping clients develop, internalize, and nurture (a) Critical Consciousness, (b) Cultural Authenticity and Self-Knowledge, (c) Radical Hope and Envisioning Possibilities, (d) Collectivism, and (e) Strength and Resistance. To better meet the needs of BIPOC clients, the stance requires clinicians to develop their critical consciousness of systemic racism and interlocking forms of oppression. The clinical case of "Brenda," a Black woman experiencing the effects of racism-related stress while raising a young Black boy, is presented. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Alfa Santoso Budiwidjojo Putra

This study aims to analyze the development of research on work engagement in Small and Medium Enterprises (SMEs) from 2020 to 2024 using a bibliometric approach. The method used is bibliometric analysis with the help of VOSviewer software for data visualization. Data was collected from the Dimensions database using the keywords "work engagement", "SMEs", and "Indonesia". The results show a significant increase in the number of publications and citations related to work engagement in SMEs during this period. Four main research clusters were identified: collaboration and communication, employee creativity and self-efficacy, innovative work behavior, and affective commitment and job satisfaction. Research trends have shifted from the basic concept of work engagement to its practical application in the context of digital transformation, innovation, and SME business sustainability. The COVID-19 pandemic has become a catalyst for research exploring the role of work engagement in SME resilience and adaptation. The need for further research integrating work engagement with contemporary issues such as digitalization and SME business resilience was revealed. The novelty of this research lies in the comprehensive analysis of work engagement research trends in Indonesian SMEs using a bibliometric approach, which has not been widely done before. This study provides a holistic mapping of the development of work engagement studies in SMEs and identifies future research directions.

Carrenina Prilly Juaninda, Imelda Ika Dian Oriza

Emerging adulthood is a transitional phase characterized by instability and uncertainty, which can lead to psychological distress among individuals transitioning from high school to adulthood. This study utilized an experimental design to assess the effectiveness of Acceptance and Commitment Therapy (ACT) training in improving subjective well-being and self-compassion. We recruited 18 emerging adults, specifically those who had recently graduated from high school, with 8 individuals in the experimental group and 10 in the control group. The training comprised four sessions, each lasting two hours. The Satisfaction with Life Scale (SWLS) and the Self-Compassion Scale (SCS) were used for measurement. Data analysis using independent sample t-tests indicated significant improvements in subjective well-being and self-compassion in the experimental group compared to the control group. The effects of the intervention remained strong at the 3-week follow-up. These findings suggest that ACT training is effective in enhancing subjective well-being and self-compassion among emerging adults experiencing psychological distress.

Julien Tempone-Wiltshire

Embodiment and mindfulness interventions provide a range of benefits for individuals living with trauma yet a lack of clarity surrounds their integration in group work practice. This article provides a framework for the integration of embodiment and mindfulness interventions in group settings for trauma. While such interventions can be utilised in primary trauma processing and open process group psychotherapy, this article provides particular guidance for the more general integration of these tools in structured format resourcing groups. Attention is given to the value and features of a phasic, staged integration of these interventions for specialised trauma-oriented group work. This article details how mindfulness and embodiment interventions support participants to cultivate the capacity to counter experiential avoidance and reorient attention towards the present moment, consequently increasing bodily and affective self-awareness. This serves to reduce patterns of reactivity, thereby supporting symptom stabilisation, improved reflective and mentalising ability, and cultivation of the self- and co-regulatory capacities necessary for trauma-processing group work. These interventions also possess supportive implications for the facilitator’s wellbeing, the formation and cohesiveness of the group, and, crucially, the norming process, both implicit and explicit. Attention is given also to safety considerations, including contraindications of mindfulness practices with certain trauma presentations, and the necessary screening requirements and exclusion criteria in the formation of a trauma-oriented group.

Rahel Klatte, B. Strauss, Christoph Flückiger et al.

Abstract Objective: Although evidence for benefits of psychotherapy is substantial, less is known about potential harm. Therefore, we systematically summarized randomized controlled trials (RCTs) to compile evidence-based data on the frequency and characteristics of adverse events (AEs) of psychotherapy. Method: This systematic review of result publications is based on a review of harm consideration in psychotherapy study protocols. Results: On the basis of 115 study protocols, 85 RCTs with 126 psychotherapy and 61 control conditions were eligible for inclusion. The sample consisted of 14,420 participants with the most common mental disorders. Harmful events, e.g., AEs, number of individuals with symptom deterioration, were explicitly reported in 60% of the studies. Conceptualization, recording, and reporting of AEs were heterogeneous. For most reported AEs, the association to study treatment remained unclear. Conclusions: Because the AE recording approaches of the individual studies differed substantially, results could only be compared to a limited extent. Consistent with other findings, this review demonstrates that AEs can be expected to affect more than one in ten participants. Serious AEs occurred more than in one in 21 participants in psychotherapy RCTs. To allow a balanced risk/benefit evaluation of psychotherapy, systematic harm monitoring and reporting should become standard in psychotherapy RCTs.

Shimrit Fisher, P. Fonagy, H. Wiseman et al.

Epistemic trust (ET) is one's ability to trust others and relies on the information they convey as being relevant and generalizable. This concept has received considerable theoretical and clinical attention, suggesting it is a promising factor in effective psychotherapy, possibly consisting of three elements: sharing, we-mode, and learning. However, for it to be used in clinical practice and research, it is imperative to (a) enhance our clinical understanding of how ET may manifest in the context of treatment and (b) understand how the process of change may occur in the course of treatment. The present study aims to identify patients' trait-like ET characteristics upon initiating treatment and explore the possible state-like changes in ET characteristics throughout treatment. Taking a discovery-oriented approach, we examined how therapists can identify a patient's level of ET at the beginning of treatment. We also examined how, within a treatment for individuals with poor pretreatment ET, the therapist and patient work interactively to bring about a positive change in ET. Identifying the process in which the therapist implements techniques in response to the patient's reactions may enable the active mechanism to be isolated and promote the first formulation of the way changes in ET occur in sequence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

J. Laver, A. McAleavey, I. Valaker et al.

Abstract Objective: Using patient-generated quantitative data in psychotherapy (feedback) appears to enhance treatment outcome, but there is variability in its effect. Different ways and reasons to implement routine outcome measurement might explain such variability. The goal of this review is to address the insufficient knowledge on how these data are used by therapists and patients. Methods: The present study is a systematic review and meta-analysis of qualitative reports of therapists’ and patients’ experiences using patient-generated quantitative data during ongoing psychotherapy. Results: Four main categories of use were identified: (1) uses of patients’ self-reported data as nomothetic/objective markers for assessment, process monitoring, and treatment planning; (2) intrapersonal uses that enhance self-awareness, initiate reflection, and influence patients’ mood or responses; (3) uses that prompt interactional processes by facilitating communication, supporting exploration, creating ownership in patients, changing treatment focus, enhancing therapeutic alliance, or disturbing the psychotherapy process; and (4) patients responding for specific purposes due to uncertainty and interpersonal motives, or strategic responding to achieve a desired result. Conclusion: These results demonstrate that patient-reported data, when used in active psychotherapy, is very clearly not just an objective measurement of client functioning: the inclusion of patient-data has the potential to influence psychotherapy in numerous ways.