Journal of Consulting and Clinical Psychology

Hoppen, Thole H.; Jehn, Marvin; Holling, Heinz; Mutz, Julian; Kip, Ahlke; Morina, Nexhmedin

doi: 10.1037/ccp0000809pmid: 37141033

Objective: A comprehensive quantitative summary of the efficacy and acceptability of psychological interventions (PIs) for adult posttraumatic stress disorder (PTSD) is lacking. Method: We conducted a systematic literature search to identify randomized controlled trials (RCTs) examining the efficacy and acceptability (all-cause dropout) of psychological interventions (i.e., trauma-focused cognitive behavior therapy [TF-CBT], eye movement desensitization and reprocessing [EMDR], other trauma-focused interventions and non-trauma-focused interventions). Results: One hundred fifty-seven RCTs were included comprising 11,565 patients. Most research (64% of RCTs) accumulated for TF-CBT. In network meta-analyses, all therapies were effective when compared to control conditions. Interventions did not differ significantly in their efficacy. Yet, TF-CBT yielded higher short- (g = 0.17, 95% CI [0.03–0.31], number of comparisons kes = 190), mid- (i.e., ≤5 months posttreatment, g = 0.23, 95% CI [0.06–0.40], kes = 73) and long-term efficacy (i.e., >5 months posttreatment, g = 0.20, 95% CI [0.04–0.35], kes = 41) than non-trauma-focused interventions. There was some evidence of network inconsistencies, and heterogeneity in outcomes was large. In pairwise meta-analysis, slightly more patients dropped out from TF-CBT than non-trauma-focused interventions (RR = 1.36; 95% CI [1.08–1.70], kes = 22). Other than that, interventions did not differ in their acceptability. Conclusions: Interventions with and without trauma focus are effective and acceptable in the treatment of PTSD. While TF-CBT yields the highest efficacy, slightly more patients discontinued TF-CBT than non-trauma-focused interventions. Altogether, the present results align with results of most previous quantitative reviews. Yet, results need to be interpreted with caution in light of some network inconsistencies and high heterogeneity in outcomes.

Domhardt, Matthias; Lutsch, Arne; Sander, Lasse B.; Paganini, Sarah; Spanhel, Kerstin; Ebert, David D.; Terhorst, Yannik; Baumeister, Harald

doi: 10.1037/ccp0000808pmid: 37104802

Objective: The mechanisms of change in digital interventions for the prevention of depression are largely unknown. Here, we explored whether five theoretically derived intervening variables (i.e., pain intensity, pain-related disability, pain self-efficacy, quality of life [QoL], and work capacity) were mediating the effectiveness of a digital intervention specifically designed to prevent depression in patients with chronic back pain (CBP). Method: This study is a secondary analysis of a pragmatic, observer-masked randomized clinical trial conducted at 82 orthopedic clinics in Germany. A total of 295 adults with a diagnosis of CBP and subclinical depressive symptoms were randomized to either the intervention group (n = 149) or treatment-as-usual (n = 146). Longitudinal mediation analyses were conducted with structural equation modeling and depression symptom severity as primary outcome (Patient Health Questionnaire–9 [PHQ-9]; 6 months after randomization) on an intention-to-treat basis. Results: Beside the effectiveness of the digital intervention in preventing depression, we found a significant causal mediation effect for QoL as measured with the complete scale of Assessment of Quality of Life (AQoL-6D; axb: −0.234), as well as for the QoL subscales mental health (axb: −0.282) and coping (axb: −0.249). All other potential intervening variables were not significant. Conclusion: Our findings suggest a relevant role of QoL, including active coping, as change mechanism in the prevention of depression. Yet, more research is needed to extend and specify our knowledge on empirically supported processes in digital depression prevention.

Constantino, Michael J.; Boswell, James F.; Coyne, Alice E.; Muir, Heather J.; Gaines, Averi N.; Kraus, David R.

doi: 10.1037/ccp0000813pmid: 37104803

Objective: Patient-reported outcomes data reveal differences both in therapists’ global effectiveness across their average patient (between-therapist effect) and in treating different problems within their caseload (within-therapist effects). Yet, it is unclear how accurately therapists perceive their own measurement-based, problem-specific effectiveness and whether such self-perceptions predict global between-therapist performance differences. We explored these questions in naturalistic psychotherapy. Method: For 50 therapists, we drew on data from a mean of 27 past patients (total N = 1,363) who completed a multidimensional outcome measure—Treatment Outcome Package (TOP)—at pre- and posttreatment. For each of 12 outcome domains (e.g., depression, anxiety), TOP data classified therapists as historically “effective,” “neutral,” or “ineffective.” Unaware of their data-driven classifications, therapists rated their perceived effectiveness for each domain. We conducted chi-square analyses to determine whether therapists predicted their own measurement-based effectiveness classifications to a level greater than chance. We then used multilevel modeling to test whether therapists’ problem-specific perceptions predicted global between-therapist performance differences. Results: For all but one outcome domain, therapists were no better than chance at predicting their measurement-based effectiveness classification. Additionally, controlling for patient baseline impairment, therapists who consistently overestimated their problem-specific effectiveness had patients who reported worse global outcomes than patients whose therapist more accurately estimated their effectiveness. Conversely, therapists who underestimated their problem-specific effectiveness had patients who reported better outcomes than patients whose therapist over- or accurately estimated their effectiveness. Conclusions: Therapist humility may differentiate the most from least globally effective therapists, and this virtue should be cultivated in clinical trainings.

Gonzalez, Carolina; Morawska, Alina; Haslam, Divna M.

doi: 10.1037/ccp0000816pmid: 37141031

Objective: To examine the relationship between health belief model (HBM; i.e., perceived threat, benefits, costs, and self-efficacy) and theory of planned behavior (TPB; i.e., attitudes, social norms, and perceived behavioral control) constructs and parents’ intention to participate and initial engagement (i.e., recruitment, enrollment, and first attendance) with a parenting intervention. Method: Participants were parents (n = 699, mean age = 38.29 years, 90.4% mothers) of 2–12-year-old children. The study conducted secondary analysis of cross-sectional data collected for an experimental study of engagement strategies. Participants provided self-report data on HBM constructs, TPB constructs, and intention to participate. Measures of initial parent engagement were also collected (i.e., recruitment, enrollment, and first attendance). Logistic regressions evaluated the impact of HBM and TPB constructs, and their combination, on intention to participate and initial parent engagement. Results: Analyses indicated that all HBM constructs increased the odds of parents’ intention to participate and enrollment. In terms of TPB, parents’ attitudes and subjective norms, but not perceived behavioral control, were significant predictors of intention to participate and enrollment. When combined in one model, parents’ perceived costs, self-efficacy, attitudes, and subjective norms predicted intention to participate, whereas perceived threat, costs, attitudes, and subjective norms increased odds of enrolling in the intervention. Regression models for first attendance were not significant and those for recruitment could not be conducted due to lack of variance. Conclusions: The findings demonstrate the relevance of using both HBM and TPB constructs when enhancing parent intention to participate and enrollment.

Dimidjian, Sona; Gallop, Robert; Levy, Joseph; Beck, Arne; Segal, Zindel V.

doi: 10.1037/ccp0000825pmid: 37458610

Objective: Digital delivery of mindfulness-based cognitive therapy through the Mindful Mood Balance (MMB) program is clinically effective (Segal et al., 2020); however, the mechanisms through which this program delivers its benefits have not been established. Method: This study investigates the differential impact of the MMB program paired with usual depression care (UDC) compared to UDC alone on the putative targets of self-reported mindfulness, decentering, and rumination and the extent to which change in these targets mediates subsequent depressive relapse among a sample of predominantly White, female participants, with residual depressive symptoms. Results: The MMB program relative to UDC was associated with a significantly greater rate of change in decentering (t = 4.94, p < .0001, d = 0.46), mindfulness (t = 6.04, p < .0001, d = 0.56), and rumination (t = 3.82, p < .0001, d = 0.36). Subsequent depressive relapse also was mediated by prior change in these putative targets, with a significant natural indirect effect for decentering, χ2(1) = 7.25, p < .008, OR = 0.57; mindfulness, χ2(1) = 9.99, p < .002, OR = 0.50; and rumination, χ2(1) = 12.95, p < .001, OR = 0.35. Conclusions: These findings suggest the mechanisms of MMB are consistent with the conceptual model for mindfulness-based cognitive therapy and depressive relapse risk and that such processes can be modified through digital delivery.