Premature termination of the unified protocol for the transdiagnostic treatment of emotional disorders: The role of ambivalence towards change

Abstract

Ambivalence towards change is an expected, recurrent process in psychological change. However, the prolonged experience of ambivalence in psychotherapy contributes to client disengagement, which could result in treatment dropout. Considering the negative effects of premature termination of therapy and the convenience of the identification of clients who are at risk of dropping out before achieving good‐outcome, the current study explored the predictive power of ambivalence for premature therapy termination using a multilevel time‐backwards model (i.e., considering the session of the dropout as session zero and then modelling what occurred from the dropout until session 1). Participants included a total of 96 psychotherapy clients (38 dropouts) treated in a university‐based clinic following the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Multilevel modelling using a time‐backwards model to analyse dropout data provided evidence of the predictive power of ambivalence evolution throughout treatment on the decision to prematurely discontinue treatment (p < .0001; R2adj = .29). Specifically, good‐outcome dropouts presented a decreasing ambivalence trend throughout treatment, whereas poor‐outcome dropouts tended to experience the same levels of ambivalence before deciding to drop out (time × dropout; β11 = .64, p = .014). Additionally, poor‐outcome dropouts presented higher levels of ambivalence (β01 = 9.92, p < .0001) in the last session. The results suggest that the pattern of client ambivalence towards change is a predictor of premature termination of therapy. Implications for clinical and research contexts are discussed.

Monitorización de Resultados en Psicoterapia: Estado Actual y Perspectivas Futuras en Iberoamérica

“…Además, la disminución de los niveles de ambivalencia del consultante entre las sesiones cuatro y ocho predice las ganancias terapéuticas. Teniendo en cuenta que la experiencia prolongada de ambivalencia puede contribuir a la desvinculación del consultante, otro estudio exploró el poder predictivo de la ambivalencia con respecto a la finalización prematura de la terapia (Oliveira et al, 2022). El análisis multinivel sugirió que la ambivalencia predecía la interrupción prematura del tratamiento, explicando más varianza que la sintomatología y la alianza terapéutica.…”

Perceived helpfulness of previous therapy: A predictor of premature termination.

“…Motivational interviewing may also be an effective strategy for clients ambivalent about treatment (Mistler et al, 2016; Ogrodniczuk et al, 2005). Indeed, wavering between wanting and not wanting to change in therapy (i.e., ambivalence) has been identified as a predictor of premature termination (Oliveira et al, 2022), which may be more common among those who enter and exit multiple unsatisfactory therapeutic experiences. Clinicians and clients would also likely benefit from routine check-ins where providers inquire about the helpfulness of current therapy and work collaboratively with clients to identify factors that are aiding or hindering the therapeutic process.…”

Abordajes transdiagnósticos en los trastornos emocionales a nivel iberoamericano: una revisión crítica

“…Diferentes trabajos realizados en nuestra región dan cuenta de la búsqueda de distintas características de los pacientes (personalidad, afectividad, estrategias de regulación emocional, severidad) que conduzcan a la personalización de estos abordajes con el consecuente aumento de su efectividad (Barrio-Martínez et al, 2022;Corpas et al, 2022;Gonçalves et al, 2022;Gonzalez-Blanch et al, 2021;González-Robles et al, 2021;Muñoz-Navarro et al, 2022;Oliveira et al, 2022;.…”