Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review.

Results from 23 studies examining associations between therapeutic relationship variables and treatment outcomes in child and adolescent therapy were reviewed with meta-analytic procedures. Results indicated that the overall strength of the relationship-outcome associations was modest and quite similar to results obtained with adults. This modest association was moderated by 1 substantive factor, type of patient problem, and 5 methodological factors, timing and source of relationship measurement, type and source of outcome, and shared versus cross-source measurement of relationship and outcome variables. Type, mode, structure, and context of treatment did not moderate associations between relationship variables and outcomes. Findings indicated that the association between the therapeutic relationship and treatment outcome was consistent across developmental levels and across diverse types and contexts of child and adolescent therapy. Recommendations for future process research on the therapeutic relationship in child psychotherapy are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of eye movement desensitization and reprocessing (EMDR) therapy on posttraumatic stress disorder in survivors of the 1999 Marmara, Turkey, earthquake.

As part of a program of response to the 1999 Marmara, Turkey, earthquake, an estimated 1,500 trauma victims with posttraumatic stress disorder (PTSD) symptoms were treated in tent cities with eye movement desensitization and reprocessing (EMDR). A field study evaluating a representative group of 41 participants with diagnosed PTSD indicated that a mean of five 90-minute sessions was sufficient to eliminate symptoms in 92.7% of those treated, with reduction in symptoms in the remaining participants. Significant reductions occurred between the pre and posttreatment PTSD Symptom Scale Self-Report version (PSS-SR) total scores and all subscales. These gains were maintained at 6-month follow-up. The same pattern of recovery was observed regardless of the use or nonuse of psychotropic medication at the time of intake. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training.

The authors examined the efficacy, speed, and incidence of symptom worsening for 3 treatments of posttraumatic stress disorder (PTSD): prolonged exposure, relaxation training, or eye movement desensitization and reprocessing (EMDR; N=60). Treatments did not differ in attrition, in the incidence of symptom worsening, or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Helping child flood victims using group EMDR intervention in Argentina: Treatment outcome and gender differences.

A comprehensive group intervention with 124 children who experienced disaster-related trauma during a massive flood in Santa Fe, Argentina, in 2003 is illustrated, utilizing a one-session group eye movement desensitization and reprocessing (EMDR) protocol. A posttreatment session was done 3 months after the treatment intervention to evaluate results. Results of this one-session treatment procedure, utilizing the EMDR-Integrative Group Treatment Protocol, showed statistically significant reduction of symptoms immediately after the intervention. These statistically significant differences were sustained at posttreatment evaluation 3 months later, as measured by psychometric scales, and by clinical and behavioral observation. Data analysis also revealed significant gender differences. Despite methodological limitations, this study supports the efficacy of EMDR group treatment in the amelioration and prevention of posttraumatic stress disorder symptoms, providing an efficient, simple, and economic (in terms of time and resources) tool for disaster-related trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The alliance as mediator of expectancy effects in short-term individual therapy.

The authors investigated the hypothesis that the therapeutic alliance mediates the relationship between pretherapy expectancy of improvement and psychotherapy outcome. Data were drawn from a comparative trial of 2 forms of short-term, time-limited individual psychotherapy (W. E. Piper, A. S. Joyce. M. McCallum, & H. F. Azim, 1998). Measures of expectancy and outcome were based on an individualized assessment of target objectives; outcome was considered from 3 perspectives (patient, independent assessor, therapist). Using the R. M. Baron and D. A. Kenny (1986) procedure, the authors, found evidence in support of the hypothesized mediation effect. The effect was evident when the alliance was rated from the perspective of either patient or therapist, and it accounted for one third of the direct impact of expectancy on outcome. Clinical implications and limitations of the study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic relationship in the brief treatment of depression: Contributions to clinical improvement and enhanced adaptive capacities.

Using data from the National Institute of Mental Health Treatment for Depression Collaborative Research Program, the authors examined the impact on treatment outcome of the patient's perception of the quality of the therapeutic relationship and contribution to the therapeutic alliance. Shared variance with early clinical improvement was removed from these relationship measures. Multilevel modeling demonstrated that a perceived positive therapeutic relationship early in treatment predicted more rapid decline in maladjustment subsequent to the relationship assessment. This effect occurred equally across all 4 treatment conditions. A positive early therapeutic relationship also predicted better adjustment throughout the 18-month follow-up as well as development of greater enhanced adaptive capacities (EAC). Controlling a wide range of patient characteristics did not eliminate the effects of the therapeutic relationship on rate of improvement during treatment and on EAC. Thus, independent of type of treatment and early clinical improvement, the therapeutic relationship contributes directly to positive therapeutic outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Responding to an identified need: A joint department of defense/department of veterans affairs training program in eye movement desensitization and reprocessing (EMDR) for clinicians providing trauma services.

An earlier study of federal Department of Defense mental health professionals found relatively few trained in the psychotherapies for posttraumatic stress disorder previously identified as effective by both this department and the federal Department of Veterans Affairs. In response to that need, a training program for one of the psychotherapies, eye movement desensitization and reprocessing (EMDR), was implemented utilizing personnel from these federal departments with assistance from a nonprofit agency. This article presents an evaluation of that program with rating data gathered from participants as well as treatment outcome data from the application of the training to patients. The program was highly rated by the participants and the impact of EMDR treatment was significant. Suggestions for similar programs and for further research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Facilitative and disruptive effects of prior exposure to shock on subsequent avoidance performance": Erratum.

Reports an error in "Facilitative and disruptive effects of prior exposure to shock on subsequent avoidance performance" by H. Anisman and T. Waller (Journal of Comparative and Physiological Psychology, 1972[Jan], Vol 78[1], 113-122). On page 114, the sentence beginning on Line 56, Column 2, should read: "Thirty seconds after placement in the compartment one half of the rats were given 10 CS (light and tone) presentations in which the CS was 9 sec. in duration, while the remaining rats received 10 CS-US presentations in which the US was a 1-ma. shock (constant current, ac) 2 sec. in duration." (The following abstract of this article originally appeared in record 1972-22565-001.) Subjected 40 male rats from each of 5 strains to 10 signaled inescapable 1-ma shock presentations. Shock facilitated subsequent 1-way and shuttle-avoidance performance (1-ma shock) in Charles River hooded, Wistar, Holtzman, and Sasco Ss, but did not significantly affect avoidance learning in Sprague-Dawley Ss. A 2nd experiment employing 120 male Holtzman rats indicated that inescapable shock of 1 ma. facilitated subsequent 1-way and shuttle-avoidance performance, while exposure to shock of 2 ma. facilitated 1-way and interfered with shuttle-avoidance performance. Movement ratings recorded during both CS and intershock intervals in pretraining were found to be good predictors of subsequent avoidance performance in preshocked Ss. Results are interpreted in terms of response repertoire changes produced by shock in conjunction with the defense reaction necessary in acquiring the avoidance response. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial.

The present study examined the impact of a brief version of an acceptance-based treatment (acceptance and commitment therapy; ACT) that teaches patients to accept unavoidable private events; to identify and focus on actions directed toward valued goals; and to defuse from odd cognition, just noticing thoughts rather than treating them as either true or false. Eighty inpatient participants with positive psychotic symptoms were randomly assigned to treatment as usual (TAU) or to 4 sessions of ACT plus TAU. ACT participants showed significantly higher symptom reporting and lower symptom believability and a rate of rehospitalization half that of TAU participants over a 4-month follow-up period. The same basic pattern of results was seen with all participant subgroups except delusional participants who denied symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of direct training and treatment integrity on treatment outcomes in school consultation.

[Correction Notice: An erratum for this article was reported in Vol 17(2) of School Psychology Quarterly (see record 2008-04568-001). The current study attempts to expand the empirical consultation research base by examining the effects of direct and indirect consultee training methods on treatment integrity and treatment outcomes. A multiple baseline design across consultation dyads was used to investigate the influence of these variables. The results suggest that direct consultee training led to higher treatment integrity. In addition, results for 3 of 4 consultation cases support the hypothesis that treatments implemented with high integrity lead to successful outcomes.] The current study attempts to expand the empirical consultation research base by examining the effects of direct and indirect consultee training methods on treatment integrity and treatment outcomes. A multiple baseline design across consultation dyads was used to investigate the influence of these variables. The results suggest that direct consultee training led to higher treatment integrity. In addition, results for 3 of 4 consultation cases support the hypothesis that treatments implemented with high integrity lead to successful outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of A CBT-practitioner’s guide to ACT: How to bridge the gap between cognitive behavioral therapy and acceptance & commitment therapy.

Reviews the book, A CBT-practitioner’s guide to ACT: How to bridge the gap between cognitive behavioral therapy and acceptance & commitment therapy by Joseph V. Ciarrochi and Ann Bailey (2008). The “third wave” of cognitive behavioural therapy (CBT), with its emphasis on mindfulness and acceptance as core skills to facilitate psychological health, has spurred the development of a number of unique and often provocative therapeutic approaches. Amongst these, acceptance and commitment therapy (ACT) is one that has generated especially fervent support amongst its adherents. The rise of ACT has been ushered in part by a plethora of treatment manuals and self-help materials; however, few of these are explicitly targeted toward professionals well-versed and comfortable with CBT who are not interested in, or ready for, a full conversion to a new therapeutic framework. It is to this audience that Ciarrochi and Bailey have targeted their book, and their successful result is a practical, easy-to-read guidebook that presents a relaxed introduction to the approach. Ciarrochi and Bailey have provided an engaging and user-friendly introduction to ACT in a fashion that will allow experienced therapists to integrate it into their work while retaining much of a basic CBT framework. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The lasting effect of words on feelings: Words may facilitate exposure effects to threatening images.

[Correction Notice: An erratum for this article was reported in Vol 8(4) of Emotion (see record 2008-12765-001). The URL provided for the supplemental materials was incorrect. The correct URL is provided in the erratum.] Previous studies have shown that mere words, particularly affective words, can dampen emotional responses. However, the effect of affective labels on emotional responding in the long term is unknown. The authors examined whether repeated exposure to aversive images would lead to more reduction in autonomic reactivity a week later if the images were exposed with single-word labels than without labels. In Experiment 1, healthy individuals were exposed to pictures of disturbing scenes with or without labels on Day 1. On Day 8, the same pictures from the previous week were exposed, this time without labels. In Experiment 2, participants were spider fearful and were exposed to pictures of spiders. In both experiments, although repeated exposure to aversive images (without labels) led to long-term attenuation of autonomic reactivity, exposure plus affective labels, but not nonaffective labels, led to more attenuation than exposure alone. Thus, affective labels may help dampen emotional reactivity in both the short and long terms. Implications for exposure therapy and translational studies are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of race on early treatment termination and outcomes in posttraumatic stress disorder treatment.

Objective:The present study investigated the influence of race on posttraumatic stress disorder (PTSD) treatment among 94 African American and 214 Caucasian female victims of interpersonal violence participating in 2 studies of cognitive–behavioral treatment for PTSD that were conducted sequentially and continuously. Method:In each study, participants were randomized into 1of 3 conditions. The first study compared cognitive processing therapy with prolonged exposure and a delayed treatment condition. In the second study, cognitive processing therapy was compared with its constituent components: cognitive therapy only and written accounts. Participants were assessed with the Clinician Administered PTSD Scale and the Structured Clinical Interview for DSM–IV, as well as through self-report measures of PTSD. Results:Analyses revealed that African Americans were significantly less likely to complete treatment compared with Caucasians (45% vs. 73%, respectively, p     

The real relationship in psychotherapy: Relationships to adult attachments, working alliance, transference, and therapy outcome.

The purpose of this study was to understand how the real relationship (RR) relates to important process and outcome variables from both the clients’ and therapists’ perspectives. Using a sample of 31 therapist/client dyads at a university counseling center, the authors examined the RR at the 3rd session of therapy and at termination. The results revealed that client adult attachment avoidance was negatively correlated with client RR, while client adult attachment anxiety was uncorrelated. Therapists’ ratings of negative transference were negatively correlated with therapist-rated RR and were uncorrelated with client-rated RR. Hierarchical linear modeling analyses were conducted to predict postintervention outcome from client and therapist perceptions of the RR. Therapists’ ratings of the RR accounted for a significant amount of variance in client posttreatment symptoms while controlling pretreatment symptoms. Client-rated RR total scores and client and therapist 3rd-session alliance scores were not significant predictors of postsymptom ratings. Implications of the usefulness of measuring the RR in psychotherapy are discussed, as are recommendations for future study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Traumatic stress: The effects of overwhelming experience on mind, body, and society.

Reviews the book, Traumatic stress: The effects of overwhelming experience on mind, body, and society edited by Bessel A. van der Kolk, Alexander C. McFarland, and Lars Weisaeth (see record 1996-98017-000). According to the reviewer, this book has, no doubt, been long awaited by professionals working in the field of traumatic stress. On the whole, it should be welcomed by psychiatrists. It leaves little reservation that, for the guiding interests of psychology, practitioners and researchers will need to look elsewhere. Although acclaimed on the flyleaf as "the gold standard reference," this book, however, falls far short of that mark, and it is bewildering and disappointing that this ambitious, extensive volume comes to so little in a field requiring lucid and advanced theoretical and empirical contributions. The book's purpose is a synthesis of what has been learned over the past 20 years about the effects of trauma, using a biopsychosocial framework. The emphasis throughout is on psychobiology and intrapersonal psychology, attention to the latter at times appearing almost quaint. The book is more properly read as a synthesis of some of the prevailing viewpoints expressed within psychiatry. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"The lasting effect of words on feelings: Words may facilitate exposure effects to threatening images": Correction to Tabibnia, Lieberman, and Craske (2008).

Reports an error in "The lasting effect of words on feelings: Words may facilitate exposure effects to threatening images" by Golnaz Tabibnia, Matthew D. Lieberman and Michelle G. Craske (Emotion, 2008[Jun], Vol 8[3], 307-317). The URL provided for the supplemental materials was incorrect. The correct URL is provided in the erratum. (The following abstract of the original article appeared in record 2008-06717-001.) Previous studies have shown that mere words, particularly affective words, can dampen emotional responses. However, the effect of affective labels on emotional responding in the long term is unknown. The authors examined whether repeated exposure to aversive images would lead to more reduction in autonomic reactivity a week later if the images were exposed with single-word labels than without labels. In Experiment 1, healthy individuals were exposed to pictures of disturbing scenes with or without labels on Day 1. On Day 8, the same pictures from the previous week were exposed, this time without labels. In Experiment 2, participants were spider fearful and were exposed to pictures of spiders. In both experiments, although repeated exposure to aversive images (without labels) led to long-term attenuation of autonomic reactivity, exposure plus affective labels, but not nonaffective labels, led to more attenuation than exposure alone. Thus, affective labels may help dampen emotional reactivity in both the short and long terms. Implications for exposure therapy and translational studies are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of early alliance ruptures and their resolution to process and outcome in three time-limited psychotherapies for personality disorders.

This study examined the relationship of early alliance ruptures and their resolution to process and outcome in a sample of 128 patients randomly assigned to 1 of 3 time-limited psychotherapies for personality disorders: cognitive–behavioral therapy, brief relational therapy, or short-term dynamic psychotherapy. Rupture intensity and resolution were assessed by patient- and therapist-report after each of the first 6 sessions. Results indicated that lower rupture intensity and higher rupture resolution were associated with better ratings of the alliance and session quality. Lower rupture intensity also predicted good outcome on measures of interpersonal functioning, while higher rupture resolution predicted better retention. Patients reported fewer ruptures than did therapists. In addition, fewer ruptures were reported in cognitive–behavioral therapy than in the other treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pilot study of the effects of expressive writing on psychological and behavioral adjustment in patients enrolled in a Phase II trial of vaccine therapy for metastatic renal cell carcinoma.

Forty-two patients with metastatic renal cell carcinoma who were participating in a Phase II clinical trial were randomly assigned to an expressive writing (EW) or neutral writing (NW) group. Patients in the EW group wrote about their cancer, and patients in the NW group wrote about health behaviors. No statistically significant group differences were found in symptoms of distress, perceived stress, or mood disturbance, except for the Vigor subscale of the Profile of Mood States. However, patients in the EW group reported significantly less sleep disturbance, better sleep quality and sleep duration, and less daytime dysfunction compared with patients in the NW group. The results suggest that EW may have sleep-related health benefits in terminally ill cancer patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)