Journal of consulting and clinical psychology最新文献

{"title":"Disruptive child behavior severity and parenting program session attendance: Individual participant data meta-analysis.","authors":"G J Melendez-Torres, Patty Leijten, Stephen Scott, Frances Gardner, Nick Axford, Maria João Seabra Santos, Ankie Menting, Judy Hutchings, Vashti Berry","doi":"10.1037/ccp0000893","DOIUrl":"10.1037/ccp0000893","url":null,"abstract":"<p><strong>Objective: </strong>We tested if baseline disruptive child behavior problem severity predicts parental attendance at sessions of a parenting group program.</p><p><strong>Method: </strong>We used a database of randomized trials of the Incredible Years parenting program in Europe and restricted the sample to participants randomized to the intervention arm. Using baseline Eyberg Child Behavior Inventory scores, we distinguished between trial-level problem severity and child-level problem severity, compared linear and quadratic functional forms at both levels, and considered cross-level interactions, all in a multilevel Poisson regression framework.</p><p><strong>Results: </strong>Drawing on 918 participants in 12 trials, we found that within trials, parents of children with the least and most severe problems attended fewer sessions. Between trials, each additional 10-point increase in the Eyberg Child Behavior Inventory trial mean predicted an 11% increase in attendance. Models including child sex, age, or family low-income did not change coefficients or their interpretation.</p><p><strong>Conclusions: </strong>Our findings suggest that although generally attendance is higher in parents of children with more challenging behavior, it seems difficult for group programs to keep families with the least or most severe problems engaged. Our findings call for the need to better understand the conditions under which lower attendance translates into equivalent or lesser program benefits. (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":" ","pages":"692-697"},"PeriodicalIF":4.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data-informed psychological therapy, measurement-based care, and precision mental health.","authors":"Wolfgang Lutz, Antonia Vehlen, Brian Schwartz","doi":"10.1037/ccp0000904","DOIUrl":"https://doi.org/10.1037/ccp0000904","url":null,"abstract":"<p><p>Measurement-based care, that is, incorporating data-informed decision support for therapists into psychological therapy, has undergone significant advancements over the past 2 decades. Technological innovations such as computerized data assessment and feedback tools have facilitated its widespread adoption across various settings. For instance, clinicians can utilize psychometric data to personalize therapeutic approaches, strategies, or modules and track a patient's response to therapy in real time (e.g., Lutz, Schwartz, & Delgadillo, 2022). Furthermore, new algorithm-based clinical support tools used within measurement-based care can optimize treatment for such patients at risk for treatment failure. Consequently, measurement-based care is evolving into a data-informed and precision psychological therapy concept that can be viewed as a low-intensity transtheoretical adjunct to evidence-based treatments. It can be integrated at multiple care points into clinical practice regardless of the clinical modality, manual, or program used in a given health care system. Therefore, it emerges as an important component of clinical competence, practice, and training, akin to continuous monitoring of physical health indicators (e.g., insulin, fever, or blood pressure). In this viewpoint article, we summarize the core concepts of data-informed psychological therapy that customizes individual psychological interventions to meet specific patient needs. We also explore implications and future steps to integrate this approach into clinical practice <i>and further advance precision mental health care</i>. (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"92 10","pages":"671-673"},"PeriodicalIF":4.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"School-based organizational skills training for students in grades 3-5: A cluster randomized trial.","authors":"Jenelle Nissley-Tsiopinis, Thomas J Power, Phylicia F Fleming, Katie L Tremont, Bridget Poznanski, Shannon Ryan, Jaclyn Cacia, Theresa Egan, Cristin Montalbano, Alex Holdaway, Ami Patel, Richard Gallagher, Howard Abikoff, A Russell Localio, Jennifer A Mautone","doi":"10.1037/ccp0000909","DOIUrl":"10.1037/ccp0000909","url":null,"abstract":"<p><strong>Objective: </strong>Research has demonstrated the effectiveness of interventions to reduce organizational skills deficits and homework problems, including the clinic-based Organizational Skills Training (OST-C) program (Abikoff et al., 2013). In this study, OST-C was adapted for schools as a small-group (Tier 2) intervention delivered by school partners (OST-T2).</p><p><strong>Method: </strong>The study was conducted in 22 schools serving students from diverse backgrounds. Students (n = 186; 122 male) in Grades 3-5, ages 8-12 (M = 9.7 years; SD = 0.88) with organizational skills deficits referred by teachers were enrolled. Schools were randomly assigned to OST-T2 or treatment as usual with waitlist. OST-T2 consisted of sixteen 35-min child sessions, two caregivers, and two teacher consultations. Outcomes were evaluated with longitudinal mixed effects modeling at posttreatment, 5-month and 12-month follow-up using caregiver and teacher reports of organizational skills, homework, and academic performance.</p><p><strong>Results: </strong>OST-T2 resulted in reductions in organizational skills deficits on caregiver and teacher report (p < .001) at posttreatment and 5-month follow-up (effect sizes [ES], Cohen's d = 0.96, 1.20). Findings also revealed a reduction in caregiver-reported homework problems at posttreatment and 5-month follow-up (p < .001, ES = 0.60, 0.72), and an improvement in teacher-rated homework at posttreatment (p = .007, ES = 0.64). Effects were attenuated at 12-month follow-up. The effects of OST-T2 on academic measures were not significant.</p><p><strong>Conclusions: </strong>Findings provide evidence for the immediate and short-term effectiveness of OST-T2 delivered by school professionals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"92 10","pages":"674-691"},"PeriodicalIF":4.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized controlled trial comparing brief online self-guided interventions for loneliness.","authors":"Benjamin T Kaveladze,Sara F Gastelum,Dong-Anh C Ngo,Paul Delacruz,Katherine A Cohen,Anton Käll,Gerhard Andersson,Jessica L Schleider,Stephen M Schueller","doi":"10.1037/ccp0000908","DOIUrl":"https://doi.org/10.1037/ccp0000908","url":null,"abstract":"OBJECTIVELoneliness is a global health issue, but current loneliness interventions are not scalable enough to reach many who might benefit from them. Brief online interventions could greatly expand access to evidence-based loneliness interventions.METHODWe conducted a preregistered three-armed trial (N = 908, ages 16-78) to compare three self-guided online interventions: a single-session intervention (SSI) for loneliness, a 3-week, three-session intervention for loneliness, and an active control supportive therapy SSI (https://ClinicalTrials.gov, ID: NCT05687162).RESULTSLoneliness decreased between baseline and Week 8 across all conditions (b = -5.80; d = -0.55; 95% CI [-0.62, -0.47]; p < .01), but did not decrease significantly more in those assigned to either the loneliness SSI (b = -1.27; d = -0.12; 95% CI [-0.30, 0.06]; p = .20) or the 3-week intervention (b = -0.93; d = -0.09; 95% CI [-0.27, 0.09]; p = .34) than those assigned to the control SSI. Participants found all three interventions acceptable but rated both loneliness interventions as more acceptable than the control (p < .01). Far more participants completed the 10-min control SSI (86.6%) and 20-min loneliness SSI (69.4%) than the 60-min 3-week intervention (14.9%).CONCLUSIONSAn SSI for loneliness was not significantly less effective than a longer loneliness intervention and had a much higher completion rate. Yet, against our hypotheses, neither loneliness intervention reduced loneliness more than an active control SSI did. Future work should aim to design more effective SSIs for loneliness and identify populations for which SSIs might be most helpful. (PsycInfo Database Record (c) 2024 APA, all rights reserved).","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"217 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emotions observed during sessions of dialectical behavior therapy predict outcome for borderline personality disorder.","authors":"Stephanie Nardone,Antonio Pascual-Leone,Ueli Kramer,Florencia Cristoffanini,Loris Grandjean,Ines Culina,Shelley McMain","doi":"10.1037/ccp0000903","DOIUrl":"https://doi.org/10.1037/ccp0000903","url":null,"abstract":"OBJECTIVEWe examined whether the emotions that clients experience within session are associated with treatment outcome in dialectical behavior therapy (DBT) for borderline personality disorder (BPD).METHODParticipants were 52 adults who met criteria for BPD and were enrolled in a 12-month DBT treatment. The Classification of Affective-Meaning States, an observer-rated measure of discrete emotions, was used to code videos of individual DBT sessions. Raters coded three psychotherapy sessions for each participant: one session from each of the early, working, and late phases of psychotherapy. Self-report measures of BPD symptoms were used to assess treatment outcome.RESULTSMore emotional experience overall during the early phase predicted fewer BPD symptoms at 12-month treatment outcome, explaining 19% of the variance in symptoms. However, increases across treatment in global distress predicted higher levels of BPD (24% of the variance explained) and depression symptoms (15% explained) at termination. Increases in emotional flexibility (i.e., variation between states) from the early to working phase predicted fewer depressive symptoms at termination (14% explained). Self-compassion coded during the working phase also predicted a better treatment outcome (explaining 19%-34%).CONCLUSIONSClients' in-session emotional experiences predict treatment outcome 8-10 months later. Clients with BPD may benefit from more overall exploration of their emotional experiences early in DBT, as well as expression of self-compassion. Increases in nonspecific, intense negative affect anticipates poor prognosis, whereas increases in emotional flexibility during early treatment anticipates better prognosis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"44 1","pages":"607-618"},"PeriodicalIF":5.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does mindfulness-based cognitive therapy with tapering support reduce risk of relapse/recurrence in major depressive disorder by enhancing positive affect? A secondary analysis of the PREVENT trial.","authors":"Barnaby D Dunn,Laura Warbrick,Rachel Hayes,Jesus Montero-Marin,Nigel Reed,Tim Dalgleish,Willem Kuyken","doi":"10.1037/ccp0000902","DOIUrl":"https://doi.org/10.1037/ccp0000902","url":null,"abstract":"OBJECTIVEMindfulness-based cognitive therapy (MBCT) is a viable alternative to maintenance antidepressant medication (M-ADM) to reduce risk of relapse/recurrence (RR) in recurrent depression, but its mechanism of action is not yet fully articulated. This secondary analysis of the PREVENT trial examined if MBCT with support to taper medication (MBCT-TS) reduces risk of RR in part by enhancing positive affect (PA).METHODIn a single-blind, parallel, group randomized controlled trial, adults with ≥3 prior depressive episodes, but not currently in episode and who were taking M-ADM, were randomized to receive either MBCT-TS or ongoing maintenance M-ADM. The primary outcome was RR over 24-month follow-up. Levels of positive affect were assessed at intake and posttreatment. The original PREVENT trial was preregistered (ISRCTN 26666654), but this secondary analysis was not.RESULTSFour hundred and twenty-four individuals (predominantly female and of White British ethnicity) were recruited, with 212 randomized to each arm. MBCT-TS led to significantly greater PA relative to M-ADM at posttreatment assessment (Δ = 2.78, 95% CI [1.47, 4.08], p < .001). RR was experienced during follow-up by 194 individuals (100 M-ADM; 94 MBCT-TS). Greater intake PA predicted a reduced hazard of RR across treatments (p < .001; hazard ratio = .96, 95% CI [0.94, 0.98]). In individuals who had not relapsed by posttreatment with complete data (121 M-ADM; 145 MBCT-TS), greater increase in PA from intake to posttreatment mediated reduced risk of subsequent RR (p = .04).CONCLUSIONSThese findings suggest that greater levels of PA predict reduced risk of RR and that MBCT-TS in part acts to protect from RR when withdrawing from M-ADM by increasing PA. (PsycInfo Database Record (c) 2024 APA, all rights reserved).","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"3 1","pages":"619-629"},"PeriodicalIF":5.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal analysis of temporal affective variability within treatment for depression.","authors":"Adar Paz, Eshkol Rafaeli, Eran Bar-Kalifa, Eva Gilboa-Schechtman, Sharon Gannot, Shrikanth S Narayanan, Dana Atzil-Slonim","doi":"10.1037/ccp0000901","DOIUrl":"10.1037/ccp0000901","url":null,"abstract":"<p><strong>Objective: </strong>Affective flexibility, the capacity to respond to life's varying environmental changes in a dynamic and adaptive manner, is considered a central aspect of psychological health in many psychotherapeutic approaches. The present study examined whether affective two-dimensional (i.e., arousal and valence) temporal variability extracted from voice and facial expressions would be associated with positive changes over the course of psychotherapy, at the session, client, and treatment levels.</p><p><strong>Method: </strong>A total of 22,741 mean vocal arousal and facial expression valence observations were extracted from 137 therapy sessions in a sample of 30 clients treated for major depressive disorder by nine therapists. Before and after each session, the clients self-reported their level of well-being on the outcome rating scale. Session-level affective temporal variability was assessed as the mean square of successive differences between consecutive two-dimensional affective measures.</p><p><strong>Results: </strong>Session outcome was positively associated with temporal variability at the session level (i.e., within clients, between sessions) and at the client level (i.e., between clients). Importantly, these associations held when controlling for average session- and client-level valence scores. In addition, the expansion of temporal variability throughout treatment was associated with steeper positive session outcome trajectories over the course of treatment.</p><p><strong>Conclusions: </strong>The continuous assessment of both vocal and facial affective expressions and the ability to extract measures of affective temporal variability from within-session data may enable therapists to better respond and modulate clients' affective flexibility; however, further research is necessary to determine whether there is a causal link between affective temporal variability and psychotherapy outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":" ","pages":"569-581"},"PeriodicalIF":4.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parent-child emotion dynamics in families presenting for behavioral parent training: Is there a link with child behavior, parenting, and treatment outcome?","authors":"Melanie S Fischer, Raelyn Loiselle, Danielle M Weber, April Highlander, Madison P McCall, Grace H Cain, Rex Forehand, Deborah J Jones","doi":"10.1037/ccp0000878","DOIUrl":"10.1037/ccp0000878","url":null,"abstract":"<p><strong>Objective: </strong>Behavioral parent training (BPT) is the standard of care for early onset behavior disorders (BDs), however, not all families benefit. Emotion regulation (ER) is one potential mechanism underlying BPT outcomes, yet there are challenges in capturing intra- and interpersonal aspects of emotion regulation within parent-child interactions that are central to BPT. This study examined how vocally encoded emotional arousal unfolds during parent-child interactions and how parents and children influence each other's arousal (Aim 1), the links between these emotion dynamics, child behavior, and parenting at baseline (Aim 2), and BPT outcome (Aim 3).</p><p><strong>Method: </strong>Families of children with BDs (<i>N</i> = 45) completed two interaction tasks and measures of parenting and child behavior. Parent-child dynamics of vocal fundamental frequency (<i>f</i>₀) were modeled using actor-partner interdependence models (APIMs) and coupled linear oscillators (CLOs).</p><p><strong>Results: </strong>When considering relative levels of <i>f</i>₀ from one talk turn to the next (APIMs), parents and children showed intrapersonal regulation and synchronizing reactivity to each other's <i>f</i>₀. When considering the shape of oscillations (CLOs), parents and children showed intrapersonal regulation but no reactivity. Intrapersonal regulation of <i>f</i>₀ during the interaction was slowed for parents with more maladaptive parenting and children with more behavior problems at baseline.</p><p><strong>Conclusions: </strong>This preliminary characterization of f0 in families presenting for BPT provides insights into the emotion dynamics potentially underlying parenting behavior and child behavior. (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":" ","pages":"543-555"},"PeriodicalIF":4.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140174905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emotional and cognitive processes in psychotherapy are associated with different aspects of the therapeutic relationship.","authors":"Ingvild Finsrud, Helene A Nissen-Lie, Pål G Ulvenes, KariAnne Vrabel, Linne Melsom, Bruce Wampold","doi":"10.1037/ccp0000853","DOIUrl":"10.1037/ccp0000853","url":null,"abstract":"<p><strong>Objective: </strong>In this naturalistic study we aimed to investigate the relationships between two central change processes (affective and cognitive) and two common relationship factors (\"Confidence in the therapist\" and \"Confidence in the treatment\"), which have been shown to impact outcomes in a clinical context. We also investigated whether these interrelationships varied across treatment orientations (i.e., cognitive or psychodynamic focused).</p><p><strong>Method: </strong>The sample consisted of 631 patients with a primary anxiety or depressive disorder who were admitted to an inpatient program and treated with psychotherapy. The data consisted of weekly measures of cognitive (i.e., \"rumination\") and affective (i.e., \"problems with emotional clarity\") change processes as well as scores on Confidence in the therapist and Confidence in the treatment and symptom distress. A multivariate version of the latent curve model with structured residuals was used to investigate the <i>within-patient effects</i> of week-to-week changes in all variables.</p><p><strong>Results: </strong>Initial analyses established that both problems with emotional clarity and rumination predicted symptom distress. Further, we found that higher Confidence in the therapist predicted higher emotional clarity (but not lower rumination) whereas higher Confidence in the treatment predicted lower rumination (but did not affect emotional clarity). Post hoc analyses found that these interrelationships varied across treatment orientation (i.e., cognitive vs. psychodynamic).</p><p><strong>Discussion: </strong>The results indicate that patients' experience of the therapist is associated with <i>emotional</i> change processes, and that patients' experience of the coherence and meaningfulness of treatment, on the other hand, is associated with <i>cognitive</i> change processes. Implications for clinical practice are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":" ","pages":"594-606"},"PeriodicalIF":4.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41115048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Location-scale modeling as an integrative approach to symptom dynamics during psychotherapy: An illustration with depressive symptoms.","authors":"Annette Brose, Peter Koval, Manuel Heinrich, Pavle Zagorscak, Johannes Bohn, Christine Knaevelsrud","doi":"10.1037/ccp0000892","DOIUrl":"10.1037/ccp0000892","url":null,"abstract":"<p><strong>Objective: </strong>Depressive symptom dynamics, including change trajectories and symptom variability, have been related to therapy outcomes. However, such dynamics have often been examined separately and related to outcomes of interest using two-step analyses, which are characterized by several limitations. Here, we show how to overcome these limitations using location-scale models in a dynamic structural equation modeling framework.</p><p><strong>Method: </strong>We introduce location-scale modeling in an accessible manner to pave the way for its use in research integrating within-person dynamics and intervention-related change in psychopathology, and we illustrate this modeling approach in a large-scale internet-based intervention for depression (<i>N</i> = 1,656). Using eight data points sampled across about 8 weeks, we predicted improvement across the intervention (50% symptom reduction) as a function of early change and symptom variability.</p><p><strong>Results: </strong>Early symptom change was associated with a more likely improvement across therapy. Variability of symptoms beyond change trajectories during the intervention was associated with less likely improvement.</p><p><strong>Conclusions: </strong>Location-scale models, and dynamic structural equation modeling more generally, are well suited to modeling how patterns of symptom change during psychotherapy are related to important (e.g., therapy) outcomes. Our illustrative application of location-scale modeling showed that symptom variability was associated with less overall improvement in depressive symptoms. However, this finding requires replication with more intensive sampling of symptoms before final conclusions can be drawn on when and how to distinguish maladaptive from adaptive variability during psychotherapy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":" ","pages":"556-568"},"PeriodicalIF":4.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}