Psychotherapy Research最新文献

{"title":"Mapping the relation between trials methodology and practice-based evidence in the real world of smaller effects: Generalizability and research recommendations.","authors":"Michael Barkham, David Saxon, Gillian E Hardy, Jaime Delgadillo, Wolfgang Lutz","doi":"10.1080/10503307.2025.2541710","DOIUrl":"10.1080/10503307.2025.2541710","url":null,"abstract":"<p><strong>Objective: </strong>To address the generalizability of results from trials (evidence-based practice) to routine practice (practice-based evidence), focusing on smaller therapist effects and differential treatment effects.</p><p><strong>Method: </strong>We utilized data from a pragmatic trial comparing cognitive behavioral therapy (CBT) and person-centered experiential therapy (PCET) as well as routine outcome data from all patients in the clinical organization in which the trial was embedded. We constructed four datasets starting with the trial assessment data and progressively extended the inclusion criteria for therapists and patients to the point of capturing the whole routine outcome dataset across the clinical organization. We applied multilevel modeling to datasets to address the stated objectives.</p><p><strong>Results: </strong>In the trial data, non-significant therapist effects became significant as a function of increasing inclusivity in the routine practice datasets, while non-significant treatment effects favoring PCET in the trial at 6 months came to favor CBT in all routine datasets. In all four datasets, shorter treatments favored PCET (≈ 6-8 sessions) and longer treatments favored CBT.</p><p><strong>Conclusion: </strong>Embedding trials within routine practice that uses the same outcome measures enables direct tests of trial generalizability. Recommendations enhancing transparency in trial reporting are made to aid generalizability of trial results to routine practice.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"829-844"},"PeriodicalIF":3.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974608","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":"The role of positive emotions in accelerated experiential dynamic psychotherapy.","authors":"Niv Gross, Eran Bar-Kalifa, Ben Shahar","doi":"10.1080/10503307.2025.2534972","DOIUrl":"10.1080/10503307.2025.2534972","url":null,"abstract":"<p><p><b>Objective:</b> Contemporary theories suggest that positive emotions play an important role in psychotherapy. The present study examined the role of positive emotions in Accelerated Experiential Dynamic Psychotherapy (AEDP), a psychotherapy approach designed to process positive emotions. <b>Method:</b> Forty-six patients, with a wide variety of psychological difficulties, participated in a 16-session course of AEDP in a naturalistic study. Following each session, participants reported the extent to which they experienced positive and negative emotions during the session, their perceived quality of the session, and their levels of functioning during the previous week. They also completed outcome measures before, at the end, and at 6-month follow-up. <b>Results:</b> Using multi-level and cross-lagged panel models, the results showed that positive emotions were associated with better session outcomes and better functioning during the following week, independent of negative emotions. Positive emotions during the entire treatment predicted improvements in depressive symptoms and interpersonal functioning but not general distress as measured directly post-treatment. However, these latter associations were nonsignificant at the 6-month follow-up. <b>Conclusion:</b> These findings provide initial evidence supporting the notion that positive emotions may be an important ingredient in psychotherapy and highlight the importance of developing interventions designed to facilitate the processing of positive emotions.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"959-970"},"PeriodicalIF":3.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144734023","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":"Psychodynamic psychotherapists' perceptions of change: A phenomenological analysis.","authors":"Lorenzo Antichi, Benedetta Biondi, Marco Giannini, Rosapia Lauro-Grotto","doi":"10.1080/10503307.2025.2535564","DOIUrl":"10.1080/10503307.2025.2535564","url":null,"abstract":"<p><p><b>Objective:</b> This qualitative study aimed to investigate how experienced psychodynamic psychotherapists conceptualize change in psychotherapy by engaging in guided reflection on their professional experiences. <b>Method:</b> Eight psychodynamic therapists participated in the study, with four females and four males. Semi-structured interviews were conducted within a phenomenological-hermeneutic research framework, focusing on several key themes related to the change in psychotherapy. Then, phenomenological categories were identified through a consensual content analysis, applying an inductive approach. <b>Results:</b> Through an iterative analysis, nine overarching themes and their respective subcategories emerged: (a) Orientation; (b) Motivations For Choosing to Train in the Psychodynamic Approach; (c) Areas of Intervention; (d) The Relational Space as the Foundation of Therapy and the Process of Change; (e) Focusing, Exploring, and Processing the Patient's Internal States; (f) The Tools of Change in the Psychodynamic Approach; (g) The Subjectivity and Experiences of the Therapist; (h) New Conceptions of Change in the Psychodynamic Approach; (i) Change as an Unpredictable Process Difficult to Model. <b>Discussion:</b> The findings underscore the importance of employing qualitative methods to study psychotherapy change, as its complexity cannot be easily reduced to simplified models.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"870-885"},"PeriodicalIF":3.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692054","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":"Dampening versus amplification: Intrapersonal and interpersonal vocal affect dynamics during psychotherapy for depression.","authors":"Adar Paz, Eshkol Rafaeli, Eran Bar-Kalifa, Eva Gilboa-Schechtman, Sharon Gannot, Shrikanth Narayanan, Dana Atzil-Slonim","doi":"10.1080/10503307.2025.2534973","DOIUrl":"10.1080/10503307.2025.2534973","url":null,"abstract":"<p><strong>Objective: </strong>Major depressive disorder (MDD) is associated with ineffective affect regulation. Vocal data can shed light on communication and expression during psychotherapy and provide high-resolution data for the study of affective arousal dynamics. Computerized vocal analyses were used to examine the extent to which intrapersonal and interpersonal vocal-arousal dynamics were linked to session outcomes and whether a session's dampening as compared to an amplification arousal trajectory would moderate this association.</p><p><strong>Method: </strong>Data from 30 clients treated for MDD by nine therapists were analyzed. A total of 9,324 vocal arousal data points were extracted from the working phases of 137 therapy sessions. The clients reported their well-being levels before and after each session on the Outcome Rating Scale.</p><p><strong>Results: </strong>Vocal-analysis revealed both intrapersonal regulation (towards one's baseline) and interpersonal regulation (towards the partner's arousal level). Only clients' interpersonal regulation towards their therapist's arousal level was linked to better session outcomes. Notably, this positive link occurred more in sessions where the client's overall arousal decreased (dampening); no such link was observed when arousal increased (amplification).</p><p><strong>Conclusions: </strong>These results suggest that interpersonal (i.e., therapist-client) affect regulation may contribute to therapeutic change in sessions characterized by overall dampening in patients diagnosed with MDD.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"929-942"},"PeriodicalIF":3.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692053","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":"Acceptability and preliminary effectiveness of the Unified Protocol in blended format in the Spanish public mental health system: Results from a Pilot Randomized Controlled Trial.","authors":"Laura Martínez-García, Carmen Schaeuffele, Óscar Peris-Baquero, María Ángeles Torres Alfosea, Jorge Osma","doi":"10.1080/10503307.2025.2541707","DOIUrl":"10.1080/10503307.2025.2541707","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the acceptability and preliminary effectiveness of the UP in blended format, combining face-to-face UP sessions with the use of the UP-App, versus Treatment as Usual (TAU) for treating Emotional disorders (ED) in Spanish specialized mental health units.</p><p><strong>Methods: </strong>A total of 76 adults presenting a diagnosis of ED were randomly assigned to UP + APP (<i>n</i> = 40) or TAU (<i>n</i> = 36) and completed self-report questionnaires at baseline, 3 and 6 months after treatment onset.</p><p><strong>Results: </strong>Improvements in both conditions for ODSIS (<i>b</i> = -2.84; <i>T</i> = -2.36), depressed mood (<i>b</i> = -6.85; <i>T</i> = 0.01), and the describing facet of mindfulness were found (<i>b</i> = 4.01; <i>T</i> = 2.31). No significant differences were found between both conditions in terms of treatment outcomes or in the Time∗Condition interaction. However, engagement with the UP-App understood as number of completed UP-App modules was related to improvements in emotion regulation and the acting with awareness facet of mindfulness, especially at 6 months, suggesting a possible time-dependent effect and UP-App modules completed. The UP-App showed good usability at 3 months (76.47) and excellent at 6 months (83.96), but low adherence (7.5% completers). Satisfaction with the treatment was similar in both conditions.</p><p><strong>Conclusions: </strong>This study suggests that the UP + APP may be as effective as TAU for ED in the SNHS. However, high dropout rates and low adherence to the UP-App constrain these results. Future research should explore a modified implementation format of the UP + APP ensuring a greater presence of the therapist, as well as an updated version of the UP-App incorporating feedback from the current study and new functionalities, in an RCT with a larger sample, as well as comparing standard UP vs UP + APP to determine the unique contribution of the UP-App on effectiveness, adherence, and user experience with UP.<b>Trial registration:</b>ClinicalTrials.gov identifier: NCT04304911.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"987-1004"},"PeriodicalIF":3.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822941","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":"Navigating under pressure: psychotherapists' experiences in a randomized controlled trial of posttraumatic stress disorder related to childhood maltreatment.","authors":"Nina Marin, Fatima Nöske, Manfred E Beutel, Andrea Hermann, Jürgen Hoyer, Christine Knaevelsrud, Iris-T Kolassa, Johannes Kruse, Falk Leichsenring, Helen Niemeyer, Simone Salzer, Karoline Sauer, Marie Siebert, Visal Tumani, Kerstin Weidner, Jörn Von Wietersheim, Christiane Steinert","doi":"10.1080/10503307.2025.2541706","DOIUrl":"10.1080/10503307.2025.2541706","url":null,"abstract":"<p><strong>Objective: </strong>Randomized controlled trials (RCTs) are considered essential for establishing the efficacy of psychotherapies. However, these settings present practical challenges and conflicts, which have contributed to a gap between science and practice. To date little is known about how psychotherapists experience participation in RCTs and why they are hesitant to engage, therefore, we aimed to explore these issues.</p><p><strong>Method: </strong>This qualitative study is nested in a multicenter RCT within the ENHANCE research network, comparing two trauma-focused psychotherapies for adults with posttraumatic stress disorder related to childhood maltreatment (PTSD-CM). Interviews were conducted with study therapists from either cognitive behavioral or psychodynamic backgrounds and were analyzed using critical-constructivist Grounded Theory methodology.</p><p><strong>Results: </strong>Analysis revealed one core category, centering around the pressure and negative emotions that therapists experienced and their attempts to manage the challenges triggering these feelings. Four clusters contributed to this core category: (1) negotiating tension between study protocol and patients' needs, (2) struggling with short-term treatment-manuals, (3) facing insecurities of deviating from everyday practice, and (4) developing greater trauma competence, given that participation in the study was subjectively experienced as successful.</p><p><strong>Conclusion: </strong>Results underscore the importance of balancing research requirements with therapeutic flexibility and highlight the need for intensive training, particularly in PTSD-CM contexts.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"886-900"},"PeriodicalIF":3.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041783","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":"The effectiveness and efficiency of brief strategic therapy: A comparison of in-person, online, and hybrid treatment delivery modalities.","authors":"Jeffrey B Jackson, Rytis Pakrosnis, Grégoire Vitry, Zoie J Bartling, Laurent Collongues, Padraic Gibson, Claudette Portelli, Matteo Papantuono","doi":"10.1080/10503307.2026.2666649","DOIUrl":"https://doi.org/10.1080/10503307.2026.2666649","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the effectiveness and efficiency of brief strategic therapy (BST) in routine care settings and examined whether outcomes and therapeutic alliance, as an indicator of positive therapeutic process, differed across in-person, online, and hybrid delivery modalities.</p><p><strong>Method: </strong>Systemic Practice Research Network (SYPRENE) data included 1,933 clients from Western Europe who received BST in one of the modalities. The nonrandomized prospective pretest-posttest naturalistic design included measures of therapist-rated and client-rated problem resolution, as well as client-rated psychological impairment, overall well-being, and therapeutic alliance.</p><p><strong>Results: </strong>On average, problem resolution was high (client-rated <i>M </i>= 6.71/10; therapist-rated <i>M </i>= 5.76/10), psychological impairment significantly decreased (<i>d </i>= -2.20), overall well-being significantly increased (<i>d </i>= 0.87), and therapeutic alliance was high with no detectable pretreatment-posttreatment change (<i>M </i>= 36.91/40). Modality was not a significant predictor of problem resolution or change in psychological impairment, overall well-being, or therapeutic alliance; clinical significance analyses largely supported these patterns. Efficiency did not differ by modality, except in-person therapy was modestly more efficient than hybrid therapy for improving overall well-being.</p><p><strong>Conclusion: </strong>BST showed effectiveness, positive therapeutic process, and efficiency across delivery modalities; modality differences were negligible or small, although some were statistically significant. Findings indicate technology-mediated BST is a feasible therapeutic alternative to expand access to care.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-20"},"PeriodicalIF":3.0,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989563","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":"How to solve the problem of low power in comparative outcome studies in psychotherapy? Commentary on Flückiger et al. (2026).","authors":"Pim Cuijpers, Mathias Harrer","doi":"10.1080/10503307.2026.2666621","DOIUrl":"https://doi.org/10.1080/10503307.2026.2666621","url":null,"abstract":"<p><p>As illustrated in the paper by Flückiger and colleagues in this issue, non-inferiority margins for randomized controlled trials comparing different bona fide psychotherapies are highly relevant. A major problem of this type of research is, however, the low statistical power of almost all trials. Even meta-analyses cannot solve this issue. In this Commentary we illustrate the problem of low power in these trials, and provide some solutions, including different types of power calculations. The main solution is, however, to convince funders that comparative outcome trials can be one of the most important ways to understand who benefits from which treatment and that large trials are very much needed.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007020","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":"Exploring the context, mechanisms, and outcomes of school-based group interpersonal therapy for depressed adolescents in Nepal: Analysis of qualitative process data from a pilot realist cluster-randomized controlled trial.","authors":"Cemile Ceren Sönmez, Sujan Shrestha, Shreeya Tamang, Bishanu Lamichaane, Helen Verdeli, Mark Jordans, Nagendra P Luitel, Chris Bonell, Kelly Rose-Clarke","doi":"10.1080/10503307.2026.2667983","DOIUrl":"https://doi.org/10.1080/10503307.2026.2667983","url":null,"abstract":"<p><strong>Objective: </strong>Evidence-based psychotherapies constitute first-line treatments for youth depression, yet their effects remain modest and largely unchanged over the past three decades. A critical gap persists in understanding how and for whom these therapies work. Realist trials address this gap by iteratively developing and testing context-mechanism-outcome configurations (CMOC) within randomized controlled trials (RCTs). As an initial step in that process, this study reports on qualitative research embedded in a pilot realist cluster RCT of group interpersonal therapy (IPT) for depressed adolescents in Nepal.</p><p><strong>Methods: </strong>Semi-structured interviews and focus groups were conducted with 41 participants purposively sampled across four schools. Data were analyzed thematically, guided by realist principles.</p><p><strong>Results: </strong>Findings highlighted key mechanisms: improved emotion regulation and problem-solving skills, reduced interpersonal conflict, closer relationships, and increased self-efficacy. Contextual factors appeared to interact with these mechanisms: adolescents from lower socioeconomic backgrounds were perceived to benefit more due to greater motivation. The experience of adversity was viewed to alter how mechanisms operated. Sharing feelings openly appeared critical for group IPT to work.</p><p><strong>Conclusion: </strong>Findings align with previous work and suggest different mechanisms might be at play for different groups. The refined CMOCs will be quantitatively tested in a forthcoming phase 3 realist RCT.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-14"},"PeriodicalIF":3.0,"publicationDate":"2026-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949891","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":"Preferences for treatment and provider characteristics in outpatient psychotherapy: Results from a discrete choice experiment.","authors":"Lara Lenz, Hans-Helmut König, André Hajek","doi":"10.1080/10503307.2026.2671190","DOIUrl":"https://doi.org/10.1080/10503307.2026.2671190","url":null,"abstract":"<p><strong>Objective: </strong>Diagnosis rates of depression and demand for psychotherapy are increasing, posing significant challenges to the mental health care system. Availability of different treatments enables patients to express their preferences. Understanding these preferences can inform policy makers and clinicians and holds the potential to increase treatment adherence and improve clinical outcomes.</p><p><strong>Method: </strong>A web survey was carried out among German adults (18-74) with psychotherapy experience, using quota sampling to reflect the gender distribution of psychotherapy-seeking adults. We conducted a discrete choice experiment to measure factors influencing the choice of psychotherapy. Included attributes were setting, delivery mode, waiting time, gender and professional experience of psychotherapist. Latent class analysis (LCA) was applied to identify preference patterns.</p><p><strong>Results: </strong>Respondents (<i>n</i> = 1575, 70.5% female, <i>M_age</i> = 47) preferred individual, face-to-face, shorter waiting times, female and more experienced therapists. Setting was most influential, followed by professional experience, waiting time, delivery mode and gender. LCA revealed five distinct classes that showed varying valuations of the attributes and their relative importance.</p><p><strong>Conclusion: </strong>Results showed that respondents mainly homogeneously preferred specific treatment characteristics. These preferences should be considered when planning mental health services. Identification of distinct preference types suggests tailored provision of mental health care.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-14"},"PeriodicalIF":3.0,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943191","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}