The impact of integrating emotion focused components into psychological therapy: A randomized controlled trial

Caspar, Franz; Berger, Thomas; Holtforth, Martin Grosse; Babl, Anna; Heer, Sara; Lin, Mu; Stähli, Annabarbara; Holstein, Dominique; Egenolf, Yvonne; Frischknecht, Eveline; Krieger, Tobias; Ramseyer, Fabian; Regli, Daniel; Schmied, Emma; Flückiger, Christoph; Brodbeck, Jeannette; Greenberg, Leslie S.; Carver, Charles S.; Castonguay, Louis G.; Kramer, Uëli; Auszra, Lars; Herrmann, Imke; Belz, Martina

doi:10.1002/jclp.23421

Cited by 5 publications

(3 citation statements)

References 28 publications

(35 reference statements)

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“…The sample of this study is part of a larger RCT with two active treatment arms: CBT + emotion-focused therapy and CBT + self-regulation. There were no significant differences in treatment effects on outcome over the intervention period between the two conditions (Caspar et al, 2022). The present study was carried out as a longitudinal study with a mixed design.…”

Section: Methodsmentioning

confidence: 90%

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Disaggregating between- and within-patient effects of ruptures and resolutions on the therapeutic alliance and symptom severity.

Babl¹,

Berger²,

Penedo³

et al. 2022

Psychotherapy

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The therapeutic alliance is considered a robust predictor of psychotherapy outcome. Ruptures and resolutions in the alliance have been the focus of recent alliance literature. Most previous studies investigated their betweenpatient effects. We used hierarchical linear models to disaggregate the between-and within-patient effects of ruptures on the alliance from patient-and therapist perspective and symptom severity. Further, the moderating effects of rupture resolutions were analyzed. The sample consisted of 56 patients diagnosed with depressive or anxiety disorders who received25 ± 3 sessions of integrativecognitive behavioral therapy in the outpatient setting. The observer-rated rupture resolution rating system was applied to all 1st, 8th, 16th and 24th therapy sessions. The alliance quality and symptom severity were assessed using self-report questionnaires after these four sessions. Results showed that a higher intensity of ruptures across treatment was associated with lower alliance ratings from both patient-and therapist perspectives during treatment. After sessions with more intense confrontation ruptures, both reported a weaker alliance. Rupture resolutions significantly moderated the withdrawal rupture effect on the alliance. The results provide meaningful practical implications for therapist feedback and training. They further underline the importance of using appropriate statistical analyses to the data structure and nature of psychotherapy to better understand the role of the alliance, rupture, and repair during therapy. Clinical Impact StatementQuestion: This study focused on answering the question how ruptures in therapy sessions are associated with the alliance and symptom severity and if rupture resolutions influence that relationship. Findings: A higher intensity of ruptures across treatment was associated with lower alliance levels during treatment. Alliance scores were lower after sessions with an unusually high intensity of confrontation ruptures. Effective resolution processes bolstered against negative effects of withdrawal ruptures on the alliance in patients who consistently withdrew from the therapist or the work of therapy. Meaning: Ruptures and resolutions may not generally be clinically relevant with regard to symptom severity in integrative CBT, however, with regard to the therapeutic alliance, resolution processes may work as some sort of buffer for the negative effect of withdrawal ruptures on symptom severity. Next Steps: Therapists might benefit from routine outcome monitoring and feedback systems that alert them if a therapy is characterized by low alliance levels, and therapists may benefit from a training to help them recognize subtler withdrawal ruptures when they occur during therapy.

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Section: Methodsmentioning

confidence: 90%

“…A total of 29 patients (51.8%) met the diagnostic criteria for unipolar depression (International Classification of Diseases [ICD-10]; F32, F33), four patients (7%) for dysthymia (ICD-10; F34), and 23 patients (41.2%) for an anxiety disorder (ICD-10; F40, F41). See Caspar et al (2022), for in- and exclusion criteria.…”

Section: Methodsmentioning

confidence: 99%

Disaggregating between- and within-patient effects of ruptures and resolutions on the therapeutic alliance and symptom severity.

Babl¹,

Berger²,

Penedo³

et al. 2022

Psychotherapy

Self Cite

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“…Patients were routinely treated with an integrative cognitive behavioral therapy (CBT) developed by Grawe (2004) known as psychological therapy. This treatment approach integrates empirically supported interventions from humanistic, systemic, and emotion-focused approaches with cognitive behavioral interventions following explicit individual case formulations within an overarching theoretical framework regarding human functioning and mechanisms of change in psychotherapy (Caspar & grosse Holtforth, 2010; Caspar et al, 2023; Grawe et al, 1990). The overarching theoretical framework is consistency theory (Grawe, 2004), and case formulations are made using plan analysis (Caspar, 2022).…”

Section: Methodsmentioning

confidence: 99%

Using machine learning algorithms to predict the effects of change processes in psychotherapy: Toward process-level treatment personalization.

Gómez Penedo,

Rubel,

Meglio

et al. 2023

Psychotherapy

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This study aimed to develop and test algorithms to determine the individual relevance of two psychotherapeutic change processes (i.e., mastery and clarification) for outcome prediction. We measured process and outcome variables in a naturalistic outpatient sample treated with an integrative treatment for a variety of diagnoses (n = 608) during the first 10 sessions. We estimated individual within-patient effects of each therapist-evaluated process of change on patient-evaluated subsequent outcomes on a session-by-session basis. Using patients’ baseline characteristics, we trained machine learning algorithms on a randomly selected subsample (n = 407) to predict the effects of patients’ process variables on outcome. We subsequently tested the predictive capacity of the best algorithm for each process on a holdout subsample (n = 201). We found significant within-patient effects of therapist perceived mastery and clarification on subsequent outcome. In the holdout subsample, the best-performing algorithms resulted in significant but small-to-medium correlations between the predicted and observed relevance of therapist perceived mastery (r = .18) and clarification (r = .16). Using the algorithms to create criteria for individual recommendations, in the holdout sample, we identified patients for whom mastery (14%) or clarification (18%) were indicated. In the mastery-indicated group, a greater focus on mastery was moderately associated with better outcome (r = .33, d = .70), while in the clarification-indicated group, the focus was not related to outcome (r = −.05, d = .10). Results support the feasibility of performing individual predictions regarding mastery process relevance that can be useful for therapist feedback and treatment recommendations. However, results will need to be replicated with prospective experimental designs.

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The impact of integrating emotion focused components into psychological therapy: A randomized controlled trial

et al. 2022

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Objectives: This paper presents a randomized controlled trial on assimilative integration, which is aimed at integrating elements from other orientations within one approach to enrich its conceptual and practical repertoire. Elements from Emotion-Focused Therapy (EFT) were integrated into a form of cognitive behavior therapy: Psychological Therapy (PT). In one treatment condition, EFT was added to PT (+EFT) with the intent to enhance therapists' working with emotions. In the other condition, concepts and interventions based on the socialpsychological selfregulation approach were added to PT (+SR). Our assumption was that the +EFT would lead to greater and deeper change, particularly in the follow-up assessments.

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The impact of integrating emotion focused components into psychological therapy: A randomized controlled trial

Cited by 5 publications

References 28 publications

Disaggregating between- and within-patient effects of ruptures and resolutions on the therapeutic alliance and symptom severity.

Disaggregating between- and within-patient effects of ruptures and resolutions on the therapeutic alliance and symptom severity.

Using machine learning algorithms to predict the effects of change processes in psychotherapy: Toward process-level treatment personalization.

The impact of integrating emotion focused components into psychological therapy: A randomized controlled trial

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