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Recent research: six papers relevant to psychotherapy

Here are six studies relevant to improving psychotherapy outcomes.  Brewin et al report on using imagery-based interventions to help people with depressioin.  Lydiard et al highlight the importance of sleep-related disturbances as a treatment target in PTSD.  McCrady and colleagues show that working with couples rather than just individuals seems more effective when using behavioural therapy to help women with alcohol use disorders.  Geerts et al describe rather amazing research investigating "The role of parental bonding and nonverbal communication in the short-term treatment response was investigated in 104 depressed outpatients. At baseline patients completed the Parental Bonding Instrument. We registered the nonverbal involvement behaviour of patients and interviewers from video recordings of baseline clinical interviews and calculated the convergence between patient-interviewer behaviour over the interview ... As hypothesized, low maternal care and high paternal overprotection predicted a poor response to an 8-week treatment.  Maternal care was positively correlated with nonverbal convergence. Moreover, convergence moderated the relationship between maternal care and the response to treatment: Lack of convergence between patients and interviewers turned out to annul the positive effects of maternal care on the treatment response. The findings link theories on early parenting to interpersonal theories of depression."  Schmeichel and colleagues show how self-affirmation of core values protects depleted energy for successful self-control - relevant both for psychotherapy and self-help.  Finally Aarons et al show how implementing evidence-based practice with a mental health and social service workforce can actually promote staff retention " ... where there is good values-innovation fit and when fidelity monitoring is designed as an aid and support to service providers in providing a high standard of care for children and families."

Brewin, C. R., J. Wheatley, et al. (2009). "Imagery rescripting as a brief stand-alone treatment for depressed patients with intrusive memories." Behav Res Ther.  Prepublication  [Abstract/Full Text]          
Many depressed patients report intrusive and distressing memories of specific events in their lives. Where present, these memories are believed to act as a maintaining factor. A series of ten patients with major depressive disorder and intrusive memories, many of them reporting severe, chronic, or recurrent episodes of depression, were given an average of 8.1 sessions of imagery rescripting as a stand-alone treatment. Hierarchical linear modelling demonstrated large treatment effects that were well maintained at one year follow-up. Seven patients showed reliable improvement, and six patients clinically significant improvement. These gains were achieved entirely by working through patients' visual imagination and without verbal challenging of negative beliefs. Spontaneous changes in beliefs, rumination, and behaviour were nevertheless observed.

Lydiard, R. B. and M. H. Hamner (2009). "Clinical Importance of Sleep Disturbance as a Treatment Target in PTSD." Focus 7(2): 176-183.  [Abstract/Full Text
In this review, evidence for the importance of sleep-related disturbances in PTSD as a target for treatment is presented. Examination of efficacy studies of the first-line treatments for posttraumatic stress disorder (PTSD)--selective serotonin reuptake inhibitors and cognitive behavior therapy--indicates that neither adequately treats PTSD nightmares and insomnia. The published guidelines that recommend these treatments do not provide advice on treating posttraumatic sleep disturbance, suggesting a possible lack of awareness of the problem. Based on clinical reports, imaging, and polysomnographic studies, a theoretical model in which REM dysregulation in PTSD plays a key role in the development and persistence of PTSD will be presented. Finally, evidence regarding the beneficial effects of prazosin and other agents in the treatment of PTSD-related sleep disturbance will be highlighted.

McCrady, B. S., E. E. Epstein, et al. (2009). "A randomized trial of individual and couple behavioral alcohol treatment for women." J Consult Clin Psychol 77(2): 243-56.  [PubMed
Although alcohol use disorders (AUDs) adversely affect women, research on efficacious treatments for women is limited. In this randomized efficacy trial of 102 heterosexual women with AUDs, the authors compared alcohol behavioral couple therapy (ABCT) and alcohol behavioral individual therapy (ABIT) on percentage of days abstinent (PDA) and percentage of days of heavy drinking (PDH) over 6 months of treatment and 12 months of posttreatment follow-up. Baseline relationship functioning and comorbid disorders were tested as moderators of outcome. Piecewise linear growth models were used to model outcomes. During treatment, women increased their PDA and decreased their PDH, with significantly greater improvements in ABCT than in ABIT (d = 0.59 for PDA; d = 0.79 for PDH). Differences favoring ABCT were maintained during follow-up. Women with poorer baseline relationship functioning improved more on PDA during treatment with ABCT than with ABIT. For PDH, results during treatment and follow-up favored ABCT for women with better baseline relationship functioning. ABCT resulted in better outcomes than ABIT for women with Axis I disorders at the end of follow-up (PDA), and for women with Axis II disorders at the end of treatment (PDA) and at the end of follow-up (PDH).

Geerts, E., T. van Os, et al. (2009). "Nonverbal communication sets the conditions for the relationship between parental bonding and the short-term treatment response in depression." Psychiatry Res 165(1-2): 120-7.  [PubMed
The role of parental bonding and nonverbal communication in the short-term treatment response was investigated in 104 depressed outpatients. At baseline patients completed the Parental Bonding Instrument. We registered the nonverbal involvement behaviour of patients and interviewers from video recordings of baseline clinical interviews and calculated the convergence between patient-interviewer behaviour over the interview. The course of depression was assessed with the Beck Depression Inventory. As hypothesized, low maternal care and high paternal overprotection predicted a poor response to an 8-week treatment. Maternal care was positively correlated with nonverbal convergence. Moreover, convergence moderated the relationship between maternal care and the response to treatment: Lack of convergence between patients and interviewers turned out to annul the positive effects of maternal care on the treatment response. The findings link theories on early parenting to interpersonal theories of depression.

Schmeichel, B. J. and K. Vohs (2009). "Self-affirmation and self-control: Affirming core values counteracts ego depletion." J Pers Soc Psychol 96(4): 770-82.  [PubMed
Research has established that acts of self-control deplete a resource required for subsequent self-control tasks. The present investigation revealed that a psychological intervention-self-affirmation-facilitates self-control when the resource has been depleted. Experiments 1 and 2 found beneficial effects of self-affirmation on self-control in a depleted state. Experiments 3 and 4 suggested that self-affirmation improves self-control by promoting higher levels (vs. lower levels) of mental construal. Self-affirmation therefore holds promise as a mental strategy that reduces the likelihood of self-control failure.

Aarons, G. A., D. H. Sommerfeld, et al. (2009). "The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: evidence for a protective effect." J Consult Clin Psychol 77(2): 270-80.  [PubMed
Staff retention is an ongoing challenge in mental health and community-based service organizations. Little is known about the impact of evidence-based practice implementation on the mental health and social service workforce. The present study examined the effect of evidence-based practice implementation and ongoing fidelity monitoring on staff retention in a children's services system. The study took place in the context of a statewide, regionally randomized effectiveness trial of an evidence-based intervention designed to reduce child neglect. In the study 21 teams consisting of 153 home-based service providers were followed over a 29-month period. Survival analyses revealed greater staff retention in the condition where the evidence-based practice was implemented along with ongoing fidelity monitoring presented to staff as supportive consultation. These results should help to allay concerns about staff retention when implementing evidence-based practices where there is good values-innovation fit and when fidelity monitoring is designed as an aid and support to service providers in providing a high standard of care for children and families.

 

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