Change in patients’ interpersonal impacts as a mediator of the alliance-outcome association in treatment for chronic depression.

Constantino, Michael J.; Laws, Holly; Coyne, Alice E.; Greenberg, Roger P.; Klein, Daniel N.; Manber, Rachel; Rothbaum, Barbara O.; Arnow, Bruce A.

doi:10.1037/ccp0000149

Cited by 23 publications

(21 citation statements)

References 38 publications

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“…At the same time, low interpersonal hostility may make it easier for patients to collaborate with their therapist and to make use of their therapy. In previous research, a stronger alliance predicted reductions in patients' hostile-submissiveness, which in turn were related to improvements in depression (Constantino et al, 2016). Besides establishing a good alliance, the experience of agency might help to abandon maladaptive interpersonal ways of relating.…”

Section: Discussionmentioning

confidence: 83%

“…In contrast, interpersonal change, which is, "stepping out" of maladaptive interpersonal cycles, would require therapists to limit their complementary reactions to their patients' interpersonal pulls and to gradually invite patients to move with more flexibility in the interpersonal space. This idea was supported by research from Constantino et al (2016) who showed that reductions in chronically depressed patients' hostile-submissiveness during therapy predict outcome. Further, the finding of the current study may be specific to the assessment of agency in an early therapy session and in the patients' subjective experience.…”

Section: Discussionmentioning

confidence: 92%

“…The most prominent complementary “pitfalls” for interaction partners of submissive and/or hostile individuals are (a) to dominate a person in response to submissive behavior and (b) to act in a hostile manner in response to hostile detached behavior (McCullough, ). Recent studies assessed depressed patients’ interpersonal impact messages on the dimensions of agency and communion both within the therapeutic dyad (Constantino et al, ) and in interactions with significant others (Grosse Holtforth, Altenstein, Ansell, Schneider, & Caspar, ) over the course of psychotherapy. Decreases in hostile‐submissiveness were associated with improvements in depression.…”

Section: Introductionmentioning

confidence: 99%

“…behavior (McCullough, 2000). Recent studies assessed depressed patients' interpersonal impact messages on the dimensions of agency and communion both within the therapeutic dyad (Constantino et al, 2016) and in interactions with significant others (Grosse Holtforth, Altenstein, Ansell, Schneider, & Caspar, 2012) over the course of psychotherapy.…”

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confidence: 99%

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Therapeutic agency, in‐session behavior, and patient–therapist interaction

et al. 2018

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Therapeutic agency, in‐session behavior, and patient–therapist interaction

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“…This model states that a novel relational experience in the therapeutic alliance is necessary for interpersonal change to occur and that this interpersonal change in turn leads to improvement of depression. To date, only one CBASP study supports this model [2]. It found an indirect effect of the alliance on outcome through patients' reduction in hostile submissiveness.…”

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confidence: 98%

Changes in Therapeutic Alliance and in Social Inhibition as Mediators of the Effect of the Cognitive Behavioral Analysis System of Psychotherapy: A Secondary Analysis from a Randomized Clinical Trial

Klein

Probst

Kriston

et al. 2020

Psychother Psychosom

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adult outpatients with early-onset PDD, CBASP leads to greater improvements in depression at the end of treatment [3] and 1 year later (but not beyond that) [4]. We conducted a sequential mediation analysis testing the hypothesis that the treatment effect (CBASP vs. SP) on outcome is mediated by a sequential indirect effect of treatment-specific improvements in the therapeutic relationship and a subsequent decrease in social inhibition.The inclusion and exclusion criteria of this RCT are described elsewhere [3]. Briefly, the acute-phase treatment consisted of 24 sessions of CBASP or SP over 20 weeks. In the continuation phase, 8 further sessions were administered between week 20 and 48. In CBASP, the therapeutic relationship is explicitly targeted using techniques that are collectively labeled disciplined personal involvement. For example, positive in-session experiences with the therapist are contrasted with hurtful reactions from significant others to promote safety in the therapeutic dyad (interpersonal discrimination exercise). SP calls for a far less structured approach to the therapeutic relationship and relies on the broader common factors of psychotherapy.Our analysis was performed in a modified intention-to-treat population that included all randomized patients for whom data were available for the mediating variables for at least 1 of the assessments (256 out of 268 patients, 95.5%). These mediating variables were the Helping Alliance Questionnaire (HAQ) and the Inventory of Interpersonal Problems (IIP). Outcome was measured using the clinician-rated Hamilton Rating Scale for Depression (HRSD-24). Out of the subsample analyzed in the current report, 130 patients (50.8%) were randomized to CBASP and 126 patients (49.2%) to SP. The mean age of the patients was 45.05 years (SD 11.8), 64.8% were female (n = 166). We imputed missing values for the HAQ, the IIP, and the HRSD-24 by using the mean of the posterior distribution from the fully conditional specification method obtained by the iterative Markov Chain Monte Carlo estimation.We examined sequential mediation via an ordinary leastsquares path analysis using a bootstrapping approach facilitated by the PROCESS macro version 2.16. The independent variable was group allocation (CBASP vs. SP), the dependent variable was the total score of the HRSD at week 48 (end of treatment), and the putative mediating variables were change of the HAQ between week 1 and the end of the acute treatment phase at week 20 (M 1 ) and subsequent change in the social inhibition subscale of the IIP during the continuation phase from week 20 to 48 (M 2 ). These time points were chosen to establish a temporal sequence of treatmentinduced changes in the therapeutic relationship followed by improvement in interpersonal functioning. For further details of the analysis, see Figure 1.This analysis revealed that a significant part of the association between treatment and outcome is mediated through the sequential indirect effect of improvement in HAQ (M 1 ) and reduction in the IIP social i...

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Patients' interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness‐based cognitive therapy and a group version of the cognitive‐behavioral analysis system of psychotherapy in chronic depression

et al. 2020

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Objectives: Interpersonal problems were examined as moderators of depression outcomes between mindfulnessbased cognitive therapy (MBCT) and cognitive behavioral analysis system of psychotherapy (CBASP) in patients with chronic depression. Methods: Patients received treatment-as-usual and, in addition, were randomized to 8-weeks of MBCT (n = 34) or 8-weeks of CBASP (n = 34). MBCT and CBASP were given in a group format. The Hamilton depression rating scale (HAM-D) was the primary and the Beck Depression Inventory (BDI-II) the secondary outcome. The subscales of the Inventory of interpersonal problems (IIP-32) were moderators. Multilevel models were performed.

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Change in patients’ interpersonal impacts as a mediator of the alliance-outcome association in treatment for chronic depression.

Abstract: Results further support CBASP change theory and suggest a candidate mechanism of the alliance's effect on outcome. (PsycINFO Database Record

Cited by 23 publications

References 38 publications

Therapeutic agency, in‐session behavior, and patient–therapist interaction

Therapeutic agency, in‐session behavior, and patient–therapist interaction

Changes in Therapeutic Alliance and in Social Inhibition as Mediators of the Effect of the Cognitive Behavioral Analysis System of Psychotherapy: A Secondary Analysis from a Randomized Clinical Trial

Patients' interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness‐based cognitive therapy and a group version of the cognitive‐behavioral analysis system of psychotherapy in chronic depression

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