Patients' progress is associated with therapists' experiences of difficulties. Yet, trait- and state-based difficulties lead to different results. Clinical or methodological significance of this article: Associations between therapists' difficulties and patient-reported outcomes depended on whether therapists' difficulties were assessed once across all patients (trait-level) or for each individual patient repeatedly during CBT (state-level). Contrary to previous research on trait-level difficulties, the difficulty professional self-doubt (PSD) was associated with a less favorable course of patients' interpersonal problems, whereas the difficulty negative personal reaction (NPR) was associated with a more favorable progress. Moreover a patient-therapist-time contextualization (state-level) seems relevant for the assessment of complex therapist variables and an elaborated understanding of the therapist effect. Altogether, CBT trainees should not be scared of their negative personal reactions towards their patients and professional self-doubt of CBT trainees should be monitored and discussed (e. g., in supervision).

Objective Patients’ sudden deterioration in symptomatology, also called sudden losses, is a rarely explored phenomenon. Method Psychological distress of 1,763 patients treated by 140 therapists was monitored after every therapy session. Patient‐reported outcome measures and patients’ therapy satisfaction was assessed. Therapists rated their experience of difficulties for every patient repeatedly over the course of therapy. Results More than one‐quarter of patients (26.5%) experienced at least one sudden loss during therapy. Patients with sudden losses did not differ significantly in psychotherapy outcome and therapy satisfaction from patients without sudden shifts. Therapists did not experience professional self‐doubt more often when working with sudden loss patients. Conclusion Sudden losses were not necessarily harmful for the outcome of psychotherapy and patients’ global therapy satisfaction. The results suggest that sudden losses can be compensated over the course of treatment.

No abstract

Background Recent findings indicated that mental disorders are associated with both an up-regulation of negative affect and a down-regulation of positive affect (PA) as distinct processes. Established treatment approaches focus on the modification of problems and negative affect only. Experimental paradigms in healthy samples and research on strengths-based approaches showed that fostering PA may improve psychotherapy process and outcome. Specific and easily implementable interventions targeting PA in treatment sessions are scarce. Mental imagery was shown to be a promising strategy for boosting positive emotional experiences. Method The PACIfIC-study is planned as a longitudinal randomized-controlled trial in the context of cognitive behavioral therapy, implemented at a German outpatient training and research center. In the process analysis, trajectories of PA over the first twelve treatment sessions will be examined with weekly questionnaires. In the intervention analysis, a six-minute positive mental imagery intervention to enhance PA will be developed and tested. The intervention is implemented with loudspeakers at the beginning of each session for a standardized induction of PA. The experimental group will be compared to an active control group (neutral mental imagery) and treatment as usual. Procedures in all treatment arms are parallelized. Main outcomes after twelve sessions of psychotherapy will be psychosocial resources, resilience and self-esteem (theory-driven), as well as psychopathology and working alliance (secondary outcome). Multilevel modeling will be conducted to address the nested data structure. Conclusion Study results may have implications on the consideration of positive constructs in mental disorders and the implementation of strengths-based interventions in psychotherapy.

No abstract