How to customize a bona fide psychotherapy for generalized anxiety disorder? A two-arms, patient blinded, ABAB crossed-therapist randomized clinical implementation trial design [IMPLEMENT 2.0]

Flückiger, Christoph; Wolfer, Christine; Held, Judith; Hilpert, Peter; Rubel, Julian; Allemand, Mathias; Zinbarg, Richard E.; Vîslă, Andreea

doi:10.1186/s12888-018-1666-2

Cited by 14 publications

(17 citation statements)

References 86 publications

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“…The study was approved by the Ethical Committee of Canton Zurich (BASEC 2016-00773). Clinically anxious participants were recruited as part of a larger randomized clinical trial (RCT) for cognitive-behavioral therapy for generalized anxiety disorder (GAD) patients [20]. In line with the recommendations of the Task Force of the European Society for rigorous HRV data quality [4], a total of 15 individuals (Anxious group: 7; Control group: 8) were excluded from data analysis due to insufficient HRV data quality.…”

Section: Participantsmentioning

confidence: 99%

Heart rate variability change during a stressful cognitive task in individuals with anxiety and control participants

et al. 2021

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Background Individuals suffering from an anxiety disorder are characterized by chronically low heart rate variability (HRV) compared to healthy individuals during resting state conditions. However, when examining HRV and HR in response to a stressor, mixed results have been obtained when comparing anxious and non-anxious groups. Methods The primary aim of the present study was to investigate HRV and HR responding in 26 clinically anxious and 14 control individuals before, during and after a stressful working memory task. Results Results indicate no between-group differences in HRV and HR at baseline. When starting the working memory task, the control group decreased significantly in HRV and the anxious group did not differ substantially in their change pattern from baseline to the start of the stressor. Finally, during the recovery phase of the working memory task, the clinically anxious and control individuals did not differ in their HFV or HR response compared to baseline. Conclusions From a clinical perspective, the results suggest that screening for the presence of anxiety disorders may help to identify patients with impaired HRV and HR functioning and to intervene on these important patient characteristics early in the treatment process.

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Section: Participantsmentioning

confidence: 99%

Heart rate variability change during a stressful cognitive task in individuals with anxiety and control participants

et al. 2021

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“…Hence, it could be interesting to study whether certain therapist characteristics that have been associated with responsiveness like empathy or interpersonal skills (Hatcher, 2015) are associated with sudden gains or losses. Further experimental implementation designs are needed to better understand the interventional causalities in process-based psychotherapy (e.g., Cheavens et al, 2012; Flückiger et al, 2016; Flückiger et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Patients’ and therapists’ actions on the precipice of change: Session processes before sudden gains and sudden losses.

Schilling

Boyle

Rubel

et al. 2021

Journal of Psychotherapy Integration

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In the present study, sessions prior to sudden gains, sudden losses, and neutral control sessions were examined regarding the processes of change resource activation, problem actuation and therapeutic alliance. With respect to these change processes, we examined whether pregain, preloss, and neutral sessions are distinguishable by particular patterns. For the current project, videos of 30 pregain, 29 preloss, and 30 neutral control sessions from n = 89 patients receiving integrative cognitive-behavioral therapy were rated minute-by-minute using Resource-Oriented Microprocess Analysis. The sample was drawn from a total of N = 365 patients, who had completed treatment or who had attended at least 20 sessions of therapy between the years of 2007 and 2011. Discriminant function and survival analyses as well as a binary logistic regression analysis were performed to identify patterns and timing of change processes associated with session types (gains, losses, and neutral sessions). The three session types differed with regard to patterns of resource activation and problem actuation. No difference concerning therapeutic alliance was found. The findings may help future studies to generate new hypotheses regarding processes that are involved in the occurrence of sudden changes.

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“…Participants ( N = 57 and 80, respectively) were participants in two randomized controlled implementation trials (IMPLEMENT; IMPLEMENT 2.0) for cognitive behavioral therapy for generalized anxiety (for the study protocols see Flückiger, 2014; Flückiger, Wolfer, et al, 2018; preregistration at ClinicalTrials.gov: NCT02039193, NCT03079336). Both trials were approved by the corresponding Ethics Committees (KEK 2011-0475 and BASEC 2016-00773).…”

Section: Methodsmentioning

confidence: 99%

The evolution of patients’ concept of the alliance and its relation to outcome: A dynamic latent-class structural equation modeling approach.

Flückiger¹,

Horvath²,

Brandt³

2022

Journal of Counseling Psychology

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The working alliance (WA) has been widely identified as the key concept for psychotherapy and allied health care services. The WA, measured at different phases of diverse kinds of therapies, has been shown to robustly predict posttreatment outcomes. But the way the clients' conceptualization of the alliance evolves overtime, and the relation between this kind of conceptual change and subsequent symptom improvements, has not been investigated. Dynamic Latent Class Structural Equation Models (DLC-SEM) were applied to data drawn from two randomized clinical trials of cognitive-behavioral therapy for generalized anxiety disorder (N = 57 and 80) to evaluate several potential models of the relation between the conceptual/ structural changes in patients' self-reports of the quality of the alliance and subsequent treatment outcomes. Inspection of the DLC-SEM models suggests that, overtime, between 63% and 66% of the better sessionlevel outcome clients switched from three factors (task, goal, bond) to an integrated single factor conceptualization of the therapeutic alliance. The study indicates that the majority of patients evolve their concept of the alliance overtime: The previously distinct alliance elements become integrated into a single factor construct. These findings suggest that if such overtime development is generalizable across diverse patient/treatment populations, future research ought to take these developments into account both methodologically (i.e., how alliance is measured) and in analyzing time-series data (e.g., using DLC-SEM). By modeling the patient's dynamic concept evolution, this initial study shows a potential to empirically explore prior theoretical propositions of the evolutions (or stability) of the alliance overtime. Public Significance StatementThis study provides empirical evidence that the majority of clients who indicate that their condition is improving from session to session, also evolve their conceptualization of the nature of their alliance with the therapist. In other words, most of the potentially good outcome patients see their collaborative relation to their therapist as a more integrated concept. If what was observed in this study can be generalized, it would imply that therapist also need to adjust their relational focus to accommodate such, more integrated notion of the alliance during therapy.

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How to customize a bona fide psychotherapy for generalized anxiety disorder? A two-arms, patient blinded, ABAB crossed-therapist randomized clinical implementation trial design [IMPLEMENT 2.0]

Cited by 14 publications

References 86 publications

Heart rate variability change during a stressful cognitive task in individuals with anxiety and control participants

Heart rate variability change during a stressful cognitive task in individuals with anxiety and control participants

Patients’ and therapists’ actions on the precipice of change: Session processes before sudden gains and sudden losses.

The evolution of patients’ concept of the alliance and its relation to outcome: A dynamic latent-class structural equation modeling approach.

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