Processes of change in cognitive behavioral therapy for treatment-resistant depression: psychological flexibility, rumination, avoidance, and emotional processing

Yasinski, Carly; Hayes, Adele M.; Ready, C. Beth; Abel, Anna; Görg, Nora; Kuyken, Willem

doi:10.1080/10503307.2019.1699972

Cited by 28 publications

(20 citation statements)

References 71 publications

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“…Two studies based on observational coding of therapy sessions found that more new learning expressed in CBT sessions did not directly predict treatment outcomes, but instead interacted with pathological processes to lessen their negative impact. In a study of cognitive therapy for treatment-resistant depression, more rumination and avoidance after a spike in depression scores predicted worse 12-month depression outcomes, but not for those who also showed new learning and flexibility across cognitive, emotional, and behavioral domains of functioning [93]. A similar interaction of old and new was reported in a sample of traumatized youth who received a trauma-focused treatment.…”

Section: Interplay Of Pathological and New Patterns Of Learningmentioning

confidence: 68%

“…In observational coding of early sessions of cognitive therapy (CT) for depression, more destabilization across components of a maladaptive depressive pattern predicted more improvement in depressive symptoms at posttreatment [4]. Similarly, more variability across cognitive, affective, and behavioral domains of functioning before sudden gains predicted better depression outcomes at 12-month follow-up in a sample with treatmentresistant depression [93]. Using a program called Grid-Ware [94,95] to quantify dispersion or movement of variables in a phase space (representation of possible states of a system), more variability in a pathological pattern with cognitive, affective, and behavioral components predicted improvement in personality disorder symptoms and also more healthy functioning after CT for personality disorders [96].…”

Section: Early Warning Signalsmentioning

confidence: 99%

“…Turning points in symptom trajectories and early warning signals can be used in psychotherapy research to isolate key change processes in a course of treatment [11]. For example, our research group has examined a patient variable called cognitive-emotional processing (considering different perspectives, making meaning, and shifting perspectives and affective responses) at three points of discontinuity (immediately before sudden gains in depression scores [93,109], after a depression spike [78], and during a period of increased variability in maladaptive personality patterns [96]). More processing at each of these change points predicted better treatment outcomes in the three studies, consistent with the view that processing might be a potential mechanism of change across treatments [57].…”

Section: Early Warning Signalsmentioning

confidence: 99%

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A complex systems approach to the study of change in psychotherapy

Hayes

Andrews

2020

BMC Med

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102

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Background: A growing body of research highlights the limitations of traditional methods for studying the process of change in psychotherapy. The science of complex systems offers a useful paradigm for studying patterns of psychopathology and the development of more functional patterns in psychotherapy. Some basic principles of change are presented from subdisciplines of complexity science that are particularly relevant to psychotherapy: dynamical systems theory, synergetics, and network theory. Two early warning signs of system transition that have been identified across sciences (critical fluctuations and critical slowing) are also described. The network destabilization and transition (NDT) model of therapeutic change is presented as a conceptual framework to import these principles to psychotherapy research and to suggest future research directions. Discussion: A complex systems approach has a number of implications for psychotherapy research. We describe important design considerations, targets for research, and analytic tools that can be used to conduct this type of research. Conclusions: A complex systems approach to psychotherapy research is both viable and necessary to more fully capture the dynamics of human change processes. Research to date suggests that the process of change in psychotherapy can be nonlinear and that periods of increased variability and critical slowing might be early warning signals of transition in psychotherapy, as they are in other systems in nature. Psychotherapy research has been limited by small samples and infrequent assessment, but ambulatory and electronic methods now allow researchers to more fully realize the potential of concepts and methods from complexity science.

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Section: Interplay Of Pathological and New Patterns Of Learningmentioning

confidence: 68%

Section: Early Warning Signalsmentioning

confidence: 99%

Section: Early Warning Signalsmentioning

confidence: 99%

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A complex systems approach to the study of change in psychotherapy

Hayes

Andrews

2020

BMC Med

Self Cite

102

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“…Psychological inflexibility is suggested as a transdiagnostic construct underlying mood disorders and so multiple constructs should be assessed in order to design effective interventions (Spinhoven et al, 2017 ). In light of research, it can be concluded that psychological flexibility is a protective factor in face of emotional distress (Trindade et al, 2020 ; Yasinski et al, 2020 ) and targeting its’ enhancement will prove beneficial in the counseling process. In this case having determined emotional schemas as another factor affecting negative emotional state, the current results will help in broadening our understanding of the interrelated mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Childhood maltreatment and emotional distress: The role of beliefs about emotion and psychological inflexibility

Taşören

2022

Curr Psychol

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The current study aimed to investigate the mediating role of negative beliefs about emotion and psychological inflexibility on the relationship between childhood maltreatment and emotional distress. A total of 519 participants completed the Childhood Trauma Questionnaire (CTQ), Depression Anxiety Stress Scale-21 (DASS-21), the Leahy Emotional Schema Scale II (LESS-II), and the Acceptance and Action Questionnaire-II (AAQ-II). All scales were significantly correlated. Two mediation analyses were tested. In the first model negative beliefs about emotion and psychological inflexibility mediated the relationship between childhood maltreatment and emotional distress measured by DASS-21 total score. In the second model, negative beliefs about emotion and psychological inflexibility mediated the relationship between childhood maltreatment and depression, anxiety, and stress measured by the subscales of DASS-21. Results suggest that maltreatment in childhood is associated with the individuals’ approaches, plans and strategies in response to emotions, and psychological inflexibility which together further determine emotional distress.

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“… 8 More importantly, improvements in scores after undergoing CBT are associated with clinical improvement in depression. 9 Unfortunately, there has previously been no evidence on how psychological flexibility affects patients with CKD despite the potential for this to be a modifiable risk factor for depression.…”

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confidence: 99%

Psychological Flexibility: A Novel Risk Factor for Depression in Kidney Disease

Drew

2020

Kidney Medicine

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Processes of change in cognitive behavioral therapy for treatment-resistant depression: psychological flexibility, rumination, avoidance, and emotional processing

Cited by 28 publications

References 71 publications

A complex systems approach to the study of change in psychotherapy

A complex systems approach to the study of change in psychotherapy

Childhood maltreatment and emotional distress: The role of beliefs about emotion and psychological inflexibility

Psychological Flexibility: A Novel Risk Factor for Depression in Kidney Disease

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