Interpersonal clarification effects in Cognitive-Behavioral Therapy for depression and how they are moderated by the therapeutic alliance

Penedo, Juan Martín Gómez; Schwartz, Brian; Deisenhofer, Anne‐Katharina; Rubel, Julian; Babl, Anna; Lutz, Wolfgang

doi:10.1016/j.jad.2020.10.043

Cited by 8 publications

(8 citation statements)

References 60 publications

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“…These results are consistent with studies that highlight the relevance of changes in interpersonal experiences as a predictor of psychotherapy outcome in CBT for GAD (Constantino et al, 2018;Coyne et al, 2019). Moreover, the results are consistent with previous findings showing maladaptive interpersonal beliefs as a predictor of CBT outcome in social phobia (Boden et al, 2012) and changes in interpersonal cognitions as a mechanism of change in CBT for depression (Go ´mez Penedo et al, 2021).…”

Section: Discussionsupporting

confidence: 92%

“…First, to measure changes in interpersonal and self-related cognitions, we used two repeatedly measured single items (i.e., one for each construct). To reduce patients' burden in longitudinal session-by-session assessments, there is a growing trend in psychotherapy research toward using single-item measures in repeated session-by-session assessment plans (Go ´mez Penedo et al, 2021;Rubel et al, 2018), although this might raise concerns regarding the specificity and validity of the particular items. As we are not aware of sound psychometric instruments to measure changes in interpersonal and self-related cognitions, it would be important to further replicate these findings with newly developed scales.…”

Section: Discussionmentioning

confidence: 99%

“…For a variety of diagnostic conditions, Rubel et al (2017;N = 1,550) found that changes in patients' interpersonal experiences during CBT predicted session-to-session symptom changes. Furthermore, a recent study in CBT for depression with 621 patients with different diagnoses indicated significant within-patient (WP) effects of changes in interpersonal cognitions on outcome (Go ´mez Penedo et al, 2021). In CBT for GAD, changes in interpersonal problems were related to better treatment responses in terms of worry reduction (Coyne et al, 2019).…”

Section: Interpersonal Processes As Predictors Of Outcome In Cbtmentioning

confidence: 99%

“…Despite the theoretical relevance of interpersonal cognitions in GAD, we failed to find any previous research directly investigating the role of interpersonal cognitions as a possible mechanism of change in CBT for GAD (Constantino et al, 2021). Specifically, interpersonal cognitions may predict subsequent symptom improvement, whereas patients' interpersonal problems at baseline may moderate this relationship (Go ´mez Penedo et al, 2021). Alternatively, changes in interpersonal cognitions effects on outcome (e.g., worry reductions) could simply be a byproduct of the more general (self-related) cognitive changes during therapy (e.g., Fitzpatrick et al, 2020).…”

Section: Interpersonal Processes As Predictors Of Outcome In Cbtmentioning

confidence: 99%

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Interpersonal cognitions as a mechanism of change in cognitive behavioral therapy for generalized anxiety disorder? A multilevel dynamic structural equation model approach.

Hilpert

Holtforth

Flückiger

2021

Journal of Consulting and Clinical Psychology

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Objective: This study aimed to investigate the effects of changes in interpersonal cognitions on outcome during cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) and how these effects are moderated by patients' interpersonal problems at intake. Method: A sample of 80 adult patients diagnosed with GAD who were undergoing CBT within a randomized controlled trial completed a questionnaire concerning interpersonal problems at baseline as well as measures of changes in interpersonal and self-related cognitions and in worry severity session by session. We conducted dynamic structural equation modeling to estimate cross-lagged within-patient effects of changes in interpersonal cognitions on worry, adjusting for the effects of self-related cognitions. Furthermore, we included interpersonal problems as a moderator of the effects of changes in interpersonal cognitions. Results: We found significant crosslagged effects of changes in both interpersonal cognitions and self-related cognitions on subsequent worry levels. Greater changes in interpersonal cognitions and self-related cognitions in a given session were associated with lower worry levels at the beginning of the next session. When adjusting for self-related cognitions, the effects of changes in interpersonal cognitions on subsequent worry remained significant. However, there were no interactive effects of changes in interpersonal cognitions by patients' interpersonal problems on worry severity. Conclusions: The results present evidence supporting changes in interpersonal cognitions and self-related cognitions as relevant change mechanisms in CBT for GAD.What is the public health significance of this article? Changes in interpersonal cognitions during cognitive behavioral therapy for generalized anxiety disorder were associated with greater outcome, even when taking into account and adjusting for changes in self-related cognitions. Therapists might benefit from enhancing these changes by engaging patients in a clarification of their interpersonal motives and relational patterns. The relevance of changes in interpersonal cognitions seems to be homogenous across patients with different levels of interpersonal problems at baseline.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Interpersonal Processes As Predictors Of Outcome In Cbtmentioning

confidence: 99%

Section: Interpersonal Processes As Predictors Of Outcome In Cbtmentioning

confidence: 99%

See 2 more Smart Citations

Interpersonal cognitions as a mechanism of change in cognitive behavioral therapy for generalized anxiety disorder? A multilevel dynamic structural equation model approach.

Hilpert

Holtforth

Flückiger

2021

Journal of Consulting and Clinical Psychology

Self Cite

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“…From a theoretical standpoint, it is plausible to assume that the considered time interval plays an influential role, as alliance is conceptualized to change over time (Bordin, 1979). This is also supported by comprehensive empirical evidence which shows that alliance and outcome fluctuate from session to session (Crits-Christoph et al, 2011;Falkenström et al, 2013;Go ´mez Penedo et al, 2020;Rubel et al, 2018) or even within sessions (Sommerfeld et al, 2008).…”

mentioning

confidence: 96%

Intraindividual dynamics between alliance and symptom severity in long-term psychotherapy: Why time matters.

Volz¹,

Jennissen²,

Schauenburg³

et al. 2021

Journal of Counseling Psychology

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Objective: The association between alliance and therapy outcome is one of the most investigated factors in psychotherapy research. However, even studies using advanced methods estimate effects over a specific time period (interval) between measurement occasions. Thus, it remains unknown how the magnitude and direction of effects depend on the considered time interval, resulting in limited comparability across studies. The current study examines the influence of time on the within-person relationship between alliance and symptom severity. Method: Alliance (WAI-SR) and symptom severity (SCL-K11) were assessed every fifth session in N = 650 patients receiving up to 100 weekly sessions (mode = 55; M = 41.03; SD = 27.23) of individual psychotherapy in a German outpatient clinic. Bivariate continuous-time (CT) structural equation modeling (SEM) was used to estimate within-person cross-and auto-effects. Results: Analysis revealed significant reciprocal within-person cross-effects with stronger relative effects of SCL-K11 on WAI-SR (a 21 ) than vice versa (a 12 ). CT analysis showed that both cross-lagged effects increased for longer time intervals with strongest effects for time intervals of about 40 sessions (a 21 = −.47; a 12 = −.19). Conclusions: Alliance and symptom severity showed a reciprocal relationship. Expanding current evidence, our analysis showed how the magnitude of these effects depends on the considered time interval. Applying CT-SEM on longitudinal data of the alliance outcome association complements current crosslagged panel analysis and allows to compare results of studies which are based on different time intervals between measurement occasions. Methodological, theoretical, and clinical implications are discussed. Public Significance StatementThis study shows that alliance predicts subsequent therapy success and vice versa in patients with longterm therapy. Moreover, our study suggests that these associations become stronger over the course of about 40 weekly sessions in patients with long-term treatment.

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The development and the effectiveness of schema therapy on Malaysian female young adults who experienced continuous trauma and post-traumatic stress disorder

Lian,

Chooi,

Bono

2024

European Journal of Trauma & Dissociation

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Interpersonal clarification effects in Cognitive-Behavioral Therapy for depression and how they are moderated by the therapeutic alliance

Cited by 8 publications

References 60 publications

Interpersonal cognitions as a mechanism of change in cognitive behavioral therapy for generalized anxiety disorder? A multilevel dynamic structural equation model approach.

Interpersonal cognitions as a mechanism of change in cognitive behavioral therapy for generalized anxiety disorder? A multilevel dynamic structural equation model approach.

Intraindividual dynamics between alliance and symptom severity in long-term psychotherapy: Why time matters.

The development and the effectiveness of schema therapy on Malaysian female young adults who experienced continuous trauma and post-traumatic stress disorder

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