Psychotherapy as it is implemented today, can be seen as the composition of unconnected groups of practitioners and scientists pursuing different theories. The idea of finding a common “umbrella” for all evidence-based treatments in the field of psychotherapy is gaining more interest. Based on this background, experts in clinical psychology from various backgrounds led a fundamental discussion about modern psychotherapy and its basic mechanisms. Process-Based Therapy (PBT) was presented by Stefan Hofmann as a possible novel approach to clinical research and practice. In this article we present the different perspectives of the four panelists on PBT and in how far the model builds a common ground for different treatment approaches. Learning mechanisms and the therapeutic alliance were almost unanimously considered as indispensable factors in a global model of psychotherapy. In conclusion, the panelists emphasized a much-needed focus on characteristics and competencies of therapists themselves e.g., in communication, listening and empathy. These core competencies should be trained and promoted independently of the therapeutic approach.

Zusammenfassung Hintergrund Kognitive Verhaltenstherapie (KVT) ist bei Depression langfristig wirksam, jedoch besteht Verbesserungsbedarf. In der Forschung zum Placeboeffekt und der Neurowissenschaft wird die zentrale Bedeutung von Erwartungen immer deutlicher. Neue Therapieansätze zur Modifikation dysfunktionaler Erwartungen (erwartungsfokussierte psychotherapeutische Interventionen, EFPI) scheinen ein vielversprechender Baustein zur Verbesserung der klassischen KVT zu sein. Ziel der Arbeit Die wesentlichen Bausteine eines EFPI-Behandlungsmanuals bei Depression werden vorgestellt. Material und Methoden Das Manual ist auf 24 Sitzungen (Kurzzeittherapie) ausgelegt. Es umfasst 5 Sitzungen Psychoedukation zu Erwartungsformulierung, -überprüfung und -verletzung sowie zur kognitiven Immunisierung (nachträgliche Umbewertung erwartungsverletzender Erfahrungen). Nach der Psychoedukation folgt eine Phase, in der in jeder Sitzung ein Verhaltensexperiment durchgeführt oder geplant wird. Die Verhaltensexperimente sollen zentrale krankheitsaufrechterhaltende Erwartungen herausfordern („Erwartungsverletzung“). Zusätzlich werden kognitive Immunisierungsstrategien besprochen und nach Möglichkeit verhindert. In der letzten Sitzung erfolgen eine Zusammenfassung und Konsolidierung des Erarbeiteten im Sinne einer Rückfallprophylaxe. Das Manual wurde in einer kleinen Pilotstudie (n = 5) erprobt. Ergebnisse Die EFPI-Therapie wurde von allen Beteiligten gut angenommen. Eine umfassende Evaluation erfolgt derzeit. Diskussion Das EFPI-Manual stellt die Fokussierung einer KVT auf möglichst viele, deutliche Erwartungsüberprüfungen bei zusätzlicher Adressierung kognitiver Immunisierung dar. Gezielt können persistierende, dysfunktionale Erwartungen von Personen mit Depression behandelt werden.

IntroductionThe effectiveness of psychotherapy in depression is subject of an ongoing debate. The mechanisms of change are still underexplored. Research tries to find influencing factors fostering the effect of psychotherapy. In that context, the dose–response relationship should receive more attention. Increasing the frequency from one to two sessions per week seems to be a promising start. Moreover, the concept of expectations and its influence in depression can be another auspicious approach. Dysfunctional expectations and the lack of their modification are central in symptom maintenance. Expectation focused psychological interventions (EFPI) have been investigated, primarily in the field of depression. The aim of this study is to compare cognitive behavioural therapy (CBT) once a week with an intensified version of CBT (two times a week) in depression as well as to include a third proof-of-principle intervention group receiving a condensed expectation focused CBT.Methods and analysisParticipants are recruited through an outpatient clinic in Germany. A current major depressive episode, diagnosed via structured clinical interviews should present as the main diagnosis. The planned randomised-controlled trial will allow comparisons between the following treatment conditions: CBT (one session/week), condensed CBT (two sessions/week) and EFPI (two sessions/week). All treatment arms include a total dose of 24 sessions. Depression severity applies as the outcome variable (Beck Depression Inventory II, Montgomery Asberg Depression Rating Scale). A sample size of n=150 is intended.Ethics and disseminationThe local ethics committee of the Department of Psychology, Philipps-University Marburg approved the study (reference number 2020-68 v). The final research article including the study results is intended to be published in international peer-reviewed journals.Trial registration numberGerman Clinical Trials Registry (DRKS00023203).

ObjectivesPersistent dysfunctional expectations seem to be core features of mental disorders. The aim of this study was to develop a questionnaire that assesses mechanisms responsible for the consistency of dysfunctional expectations. Processes before (i.e., assimilation) and after (i.e., immunization) expectation-violating experiences have been considered.DesignThe Immunization Scale (IMS) is constructed and validated with the help of an explorative (EFA) and confirmatory factor analysis (CFA) in two conducted studies.Materials and methodsFor the first study, the initially formulated 75-item version was completed online by 230 (range 18–69) participants from a convenience sample. For the second study, 299 (range 18–62) participants completed the reduced scale at the first measurement point, 75 participants thereof also 1 month later. For validity and reliability analyses, participants in both studies provided demographic information, the Beck Depression Inventory (BDI-II), the Depressive Expectation Scale (DES), the Beck Anxiety Inventory (BAI), and the German version of the Acceptance and Action Questionnaire (FAH-II).ResultsThe initial 75 items were reduced to 23 items. The EFA revealed three main factors, namely, negative expectations, assimilation, and cognitive immunization. The three-factor structure could be confirmed in study 2 by the CFA. Reliability measures showed an excellent internal consistency for the entire IMS. A very good test–retest reliability was found. Significant correlations resulted between the IMS and DES, BDI-II, BAI, and FAH-II, the highest for DES and FAH-II.ConclusionPsychometric properties of the IMS are promising. Future studies should verify the reliability and validity measures in other population samples. The IMS can be very useful in expectation research, especially in the examination of expectation-focused therapy.