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Miles to Go Before We Sleep: Advancing the Understanding of Psychotherapy by Modeling Complex Processes

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Abstract

One of the main debates in the study of psychotherapy is whether specific techniques are best indicated for different problems or whether “common factors” better account for the efficacy of psychotherapy. Evidence for the superiority of specific techniques is mixed and limited to a handful of diagnoses. By contrast, evidence for the importance of common factors is riddled with methodological weaknesses and may be of limited clinical utility. The stagnation in this debate may reflect that the research methods heretofore employed have reached a plateau in their ability to advance knowledge regarding psychotherapy processes. The articles of the special issue move beyond simple bivariate relationship and attempt to model the real-world complexity involved in the process of psychotherapy. It is argued that these types of investigations, which model the interactions of patient characteristics as well as multiple specific and “common factors,” are the best way to advance the state of knowledge regarding psychotherapy processes.

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References

  • Arnow, B. A., Steidtmann, D., Blasey, C., Manber, R., Constantino, M. J., Klein, D. N., … Fisher, A. J. (2013). The relationship between the therapeutic alliance and treatment outcome in two distinct psychotherapies for chronic depression. Journal of Consulting and Clinical Psychology, 81, 627–638.

    Article  PubMed  PubMed Central  Google Scholar 

  • Barth, J., Munder, T., Gerger, H., Nüesch, E., Trelle, S., Znoj, H., … Cuijpers, P. (2013). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: A network meta-analysis. PLoS Medicine, 10, e1001454.

    Article  PubMed  PubMed Central  Google Scholar 

  • Beutler, L. E., Harwood, T. M., Michelson, A., Song, X., & Holman, J. (2011). Resistance/reactance level. Journal of Clinical Psychology, 67, 133–142.

    Article  PubMed  Google Scholar 

  • Brückl, T. M., Wittchen, H. -U., Höfler, M., Pfister, H., Schneider, S., & Lieb, R. (2007). Childhood separation anxiety and the risk of subsequent psychopathology: Results from a community study. Psychotherapy and Psychosomatics, 76, 47–56. https://doi.org/10.1159/000096364.

  • Chekroud, A. M. (2017). Bigger data, harder questions—Opportunities througout mental health care. JAMA Psychiatry, 74, 1183–1184.

    Article  PubMed  Google Scholar 

  • Crawford, E. A., Frank, H. E., Palitz, S. A., Davis, J. P., & Kendall, P. C. (2018). Process factors associated with improved outcomes in CBT for anxious youth: Therapeutic content, alliance, and therapist actions. Cognitive Therapy and Research, this issue. https://doi.org/10.1007/s10608-017-9864-7.

    Google Scholar 

  • Dawes, R. (1994). House of cards: Psychology and psychotherapy built on myth. New York: Free Press.

    Google Scholar 

  • DeRubeis, R. J., Brotman, M. A., & Gibbons, C. J. (2005). A conceptual and methodological analysis of the nonspecifics argument. Clinical Psychology: Science and Practice, 12, 174–183.

    Google Scholar 

  • DeRubeis, R. J., Cohen, Z. D., Forand, N. R., Fournier, J. C., Gelfand, L. A., & Lorenzo-Luaces, L. (2014a). The Personalized Advantage Index: Translating research on prediction into individualized treatment recommendations. A demonstration. PLoS ONE, 9, e83875.

    Article  PubMed  PubMed Central  Google Scholar 

  • DeRubeis, R. J., Gelfand, L. A., German, R. E., Fournier, J. C., & Forand, N. R. (2014b). Understanding processes of change: How some patients reveal more than others—And some groups of therapists less—About what matters in psychotherapy. Psychotherapy Research, 24, 419–428.

    Article  PubMed  Google Scholar 

  • DeRubeis, R. J., & Lorenzo-Luaces, L. (2016). In pursuit of truth but recognizing it is unattainable and attending to the most informative evidence. Psychotherapy Research, 27, 33–35.

    Article  Google Scholar 

  • Doss, B. D. (2004). Changing the way we study change in psychotherapy. Clinical Psychology: Science and Practice, 11, 368–386.

    Google Scholar 

  • Falkenström, F., Granström, F., & Holmqvist, R. (2013). Therapeutic alliance predicts symptomatic improvement session by session. Journal of Counseling Psychology, 60, 317–328.

    Article  PubMed  Google Scholar 

  • Hoet, A. C., Burgin, C. J., Eddington, K. M., & Silvia, P. J. (2018). Reports of therapy skill use and their efficacy in daily life in the short-term treatment of depression. Cognitive Therapy and Research, this issue. https://doi.org/10.1007/s10608-017-9852-y.

    Google Scholar 

  • Hofmann, S. G., & Barlow, D. H. (2014). Evidence-based psychological interventions and the common factors approach: The beginnings of a rapprochement? Psychotherapy, 51, 510–513.

    Article  PubMed  Google Scholar 

  • Hooke, G. R., Sng, A. A. H., Cunningham, N. K., & Page, A. C. (2018). Methods of delivering feedback to optimise patient outcomes: The value of expected treatment trajectories. Cognitive Therapy and Research, this issue. https://doi.org/10.1007/s10608-017-9851-z.

    Google Scholar 

  • Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9–16.

    Article  PubMed  Google Scholar 

  • Huibers, M. J., Cohen, Z. D., Lemmens, L. H., Arntz, A., Peeters, F. P., Cuijpers, P., & DeRubeis, R. J. (2015). Predicting optimal outcomes in cognitive therapy or interpersonal psychotherapy for depressed individuals using the personalized advantage index approach. PLoS ONE, 10, e0140771.

    Article  PubMed  PubMed Central  Google Scholar 

  • Joyce, A. S., Ogrodniczuk, J. S., Piper, W. E., & McCallum, M. (2003). The alliance as mediator of expectancy effects in short-term individual therapy. Journal of Consulting and Clinical Psychology, 71, 672–679.

    Article  PubMed  Google Scholar 

  • Kendell, R., & Jablensky, A. (2003). Distinguishing between the validity and utility of psychiatric diagnoses. American Journal of Psychiatry, 160, 4–12.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Van Loo, H. M., Wardenaar, K. J., Bossarte, R. M., Brenner, L. A., Ebert, D. D., … Schoevers, R. A. (2017). Using patient self-reports to study heterogeneity of treatment effects in major depressive disorder. Epidemiology and Psychiatric Sciences, 26, 22–36.

    Article  CAS  PubMed  Google Scholar 

  • Lambert, M. J., & Shimokawa, K. (2011). Collecting client feedback. Psychotherapy, 48, 72–79.

    Article  PubMed  Google Scholar 

  • Laska, K. M., Gurman, A. S., & Wampold, B. E. (2014). Expanding the lens of evidence-based practice in psychotherapy: A common factors perspective. Psychotherapy, 51, 467–481.

    Article  PubMed  Google Scholar 

  • Lorenzo-Luaces, L., DeRubeis, R. J., van Straten, A., & Tiemens, B. (2017). A prognostic index (PI) as a moderator of outcomes in the treatment of depression: A proof of concept combining multiple variables to inform risk-stratified stepped care models. Journal of Affective Disorders, 213, 78–85.

    Article  PubMed  Google Scholar 

  • Lorenzo-Luaces, L., DeRubeis, R. J., & Webb, C. A. (2014). Client characteristics as moderators of the relation between the therapeutic alliance and outcome in cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 82, 368–373.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lorenzo-Luaces, L., Driessen, E., DeRubeis, R. J., Van, H. L., Keefe, J. R., Hendriksen, M., & Dekker, J. (2017). Moderation of the alliance-outcome association by prior depressive episodes: Differential effects in cognitive-behavioral therapy and short-term psychodynamic supportive psychotherapy. Behavior Therapy, 48, 581–595.

    Article  PubMed  Google Scholar 

  • Renna, M. E., Seeley, S. H., Heimberg, R. G., Etkin, A., Fresco, D. M., & Mennin, D. S. (2018). Increased attention regulation from emotion regulation therapy for generalized anxiety disorder. Cognitive Therapy and Research, this issue. https://doi.org/10.1007/s10608-017-9872-7.

    Google Scholar 

  • Sasso, K. E., Strunk, D. R., Braun, J. D., DeRubeis, R. J., & Brotman, M. A. (2016). A re-examination of process–outcome relations in cognitive therapy for depression: Disaggregating within-patient and between-patient effects. Psychotherapy Research, 26, 387–398.

    Article  PubMed  Google Scholar 

  • Sauer-Zavala, S., Boswell, J. F., Bentley, K. H., Thompson-Hollands, J., Farchione, T. J., & Barlowa, D. H. (2018). Expectancies, working alliance, and outcome in transdiagnostic and single diagnosis treatment for anxiety disorders: An investigation of mediation. Cognitive Therapy and Research, this issue. https://doi.org/10.1007/s10608-017-9855-8.

    Google Scholar 

  • Soriano, M. D. A. (2014). Efecto en los resultados del tratamiento psicológico de la competencia y adherencia del terapeuta a los protocolos de tratamiento: Un meta-análisis. (Unpublished doctoral dissertation). Universidad de Murcia, Murcia, España).

  • Webb, C. A., Beard, C., Auerbach, R. P., Menninger, E., & Björgvinsson, T. (2014). The therapeutic alliance in a naturalistic psychiatric setting: Temporal relations with depressive symptom change. Behaviour Research and Therapy, 61, 70–77.

    Article  PubMed  PubMed Central  Google Scholar 

  • Webb, C. A., DeRubeis, R. J., & Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 200–211.

    Article  PubMed  PubMed Central  Google Scholar 

  • Westra, H. A., & Norouzian, N. (2018). Using motivational interviewing to manage process markers of ambivalence and resistance in cognitive behavioral therapy. Cognitive Therapy and Research, this issue. https://doi.org/10.1007/s10608-017-9857-6.

    Google Scholar 

  • Zickgraf, H. F., Chambless, D. L., McCarthy, K. S., Gallop, R., Sharpless, B. A., Milrod, B. L., & Barber, J. P. (2016). Interpersonal factors are associated with lower therapist adherence in cognitive–behavioural therapy for panic disorder. Clinical Psychology & Psychotherapy, 23, 272–284.

    Article  Google Scholar 

  • Zilcha-Mano, S., Lipsitz-Odess, I., & Errázuriz, P. (2018a). When is it effective to focus on the alliance? Analysis of a within-client moderator. Cognitive Therapy and Research, this issue. https://doi.org/10.1007/s10608-017-9867-4.

    Google Scholar 

  • Zilcha-Mano, S., Muran, J. C., Eubanks, C. F., Safran, J. D., & Winston, A. (2018b). Not just a non-specific factor: Moderators of the effect of within- and between-clients alliance on outcome in CBT. Cognitive Therapy and Research, this issue. https://doi.org/10.1007/s10608-017-9866-5.

    Google Scholar 

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Correspondence to Lorenzo Lorenzo-Luaces.

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Lorenzo-Luaces, L., DeRubeis, R.J. Miles to Go Before We Sleep: Advancing the Understanding of Psychotherapy by Modeling Complex Processes. Cogn Ther Res 42, 212–217 (2018). https://doi.org/10.1007/s10608-018-9893-x

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