"Clinical significance of psychotherapy for unipolar depression: A meta-analytic approach to social comparison": Correction to Nietzel et al.

Reports an error in "Clinical significance of psychotherapy for unipolar depression: A meta-analytic approach to social comparison" by Michael T. Nietzel, Robert L. Russell, Kelly A. Hemmings and Monica L. Gretter (Journal of Consulting and Clinical Psychology, 1987[Apr], Vol 55[2], 156-161). The data presented in Table 2 were incorrect because a row and a column were inadvertently omitted. The corrected Table 2 appears in the erratum. (The following abstract of the original article appeared in record 1987-28817-001.) This study used meta-analysis to study the clinical significance of psychotherapy for symptoms of unipolar depression. The following questions were addressed: How similar is the posttherapy adjustment of depressed adults to that of nondepressed adults? Is this adjustment maintained at follow-up? What dimensions of treatment, therapists, or design are associated with clinical significance? Using the Beck Depression Inventory (BDI), we calculated composite BDI norms from 28 published studies. Sixty effect sizes (from 31 outcome studies utilizing the BDI) were calculated. The results indicated that psychotherapy produces outcomes that have moderate clinical significance and that are well-maintained at follow-up, that individual therapy is associated with greater clinical significance than group treatment, and that type of therapy is not related to improvement. Alternative approaches for operationalizing clinical significance as the return of individuals to normal levels of functioning are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital adjustment and outcome following treatments for depression.

Marital adjustment and treatment outcome were evaluated in the Treatment of Depression Collaborative Research Program, a multicenter clinical trial evaluating interpersonal psychotherapy, cognitive therapy, imipramine, and placebo. Marital adjustment and depression were assessed pre- and posttreatment, and depression was assessed at 6, 12, and 18 months after treatment. Results indicate that (1) there was a significant improvement in marital adjustment after treatment, (2) this effect was not moderated by treatment type, and (3) this effect was mediated by change in depression. Poor pretreatment marital adjustment was modestly associated with negative outcome, whereas poor posttreatment marital adjustment was strongly associated with negative outcome during follow-up. The findings suggest that poor marital adjustment at the end of active treatment is a risk factor for increases in depression severity during follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rapid response to psychosocial treatment for adolescent depression: a two-year follow-up

OBJECTIVE: To examine the differential course and treatment outcome of patients who participated in a randomized clinical trial, comparing cognitive, family, and supportive psychotherapies for adolescent major depressive disorder. METHOD: In a sample of 100 depressed adolescents, remission, clinical recovery, recurrence, and functional improvement were examined at the end of acute treatment and at 1- and 2-year follow-up, according to their type of response to treatment. Rapid response was defined as a decline of > or = 50% in the Beck Depression Inventory (BDI) score from pretreatment until the beginning of the second session of psychotherapy, intermediate as a decline of < 50% but > 0%, and initial nonresponse as a BDI score that stayed the same or increased. RESULTS: Rapid responders showed a better outcome at acute treatment, 1-year, and in some measures, 2-year follow-up. For those who had recurrences over time, rapid responders showed a longer period before recurrence. Subjects were most likely to respond rapidly, or not at all, in the supportive cell. CONCLUSIONS: These findings suggest that milder forms of depression may benefit from initial supportive therapy or short trials of more specialized types of psychotherapy. The use of a placebo run-in period might help to "wash out" nonspecific responders.     

The efficacy of group psychotherapy for older adult clients: A meta-analysis.

This review examined the effectiveness of group psychotherapy for older (55+) adults. Results from 44 studies with pre-post designs and 27 controlled studies indicated that group psychotherapy benefits older adults, with average rs of .42 and .24 for pre-post and controlled designs, respectively. The type of therapy provided and the age of the clients were associated with pretreatment to posttreatment improvement. Clients in cognitive-behavioral group therapy improved more than those receiving reminiscence therapy. The older the average age of the group members, the less they benefited from therapy. Number of sessions attended, length of therapy sessions, the percentage of women in the group, and client living situation were not significant moderators of outcome. Overall, group interventions for older adults appear to be effective and the average effect size for pre-post studies was quite similar to those yielded by meta-analyses of group therapy with younger adults and adolescents. However, the average effect size for controlled studies of group therapy with older adults appears to be somewhat smaller than the values reported in meta-analyses with younger clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of Psychotherapeutic Benefit of Lesbian, Gay, and Bisexual Clients: The Effects of Sexual Orientation Matching and Other Factors.

[Correction Notice: An erratum for this article was reported in Vol 41(1) of Psychotherapy: Theory, Research, Practice, Training (see record 2007-16875-001). On page 293, Table 3 is incorrectly identified as Table 2, and on pages 294-295, Table 2 is incorrectly identified as Table 3.] Predictors of the level of benefit derived from nearly 2,000 psychotherapy episodes reported by a nationwide, nonprobability sample of 600 lesbian, gay, and bisexual clients were analyzed using ordinary least squares regression, corrected by generalized-estimating-equation (GEE) procedures for lack of independence in the data. Among the positive predictors of benefit are the following: the year the episode began; the number of sessions in the episode; the client's identifying him- or herself as gay, lesbian, or bisexual at the beginning of the episode and being unconflicted about it; and having a therapist who is female, gay, or lesbian or who trained as a social worker or a psychologist. Negative predictors include having a therapist who is an analyst, who uses reparative therapy, or who violates sexual boundaries. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy for intermittent explosive disorder: A pilot randomized clinical trial.

No randomized clinical trials have evaluated the efficacy of psychotherapy for intermittent explosive disorder (IED). In the present study, the authors tested the efficacy of 12-week group and individual cognitive-behavioral therapies (adapted from J. L. Deffenbacher & M. McKay, 2000) by comparing them with a wait-list control in a randomized clinical trial among adults with IED (N = 45). Aggression, anger, and associated symptoms were assessed at baseline, midtreatment, posttreatment, and 3-month follow-up. Group and individual cognitive-behavioral therapy tended not to differ, with each reducing aggression, anger, hostile thinking, and depressive symptoms, while improving anger control relative to wait-list participants. Posttreatment effect sizes were large. These effects were maintained at 3-month follow-up. Findings provide initial support for the use of multicomponent cognitive-behavioral therapy in the treatment of IED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of prognostic information on global ratings of psychotherapy outcome.

30 graduate students in clinical psychology (raters) viewed a videotape recording of an interview with a patient after having read 1 of 3 types of posttherapy information about the patient. One group of raters was presented information associated with a good prognosis, one group was presented information associated with a poor prognosis, and the last group received neutral information about the patient. Half of the members of each group were told that the interview was made at the termination of therapy, the other half were told that it was a 1-yr follow-up interview. All raters then completed scales regarding patient's level of adjustment, psychic distress, amount of change, and success of patient's therapy. Only ratings of pre- to posttherapy patient change varied as a function of prognostic information. Results suggest that although poor prognosis patients are perceived as exhibiting more change than good prognosis patients, only final level of functioning determines global judgments of psychotherapy outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Similarities and differences between practitioners of psychotherapy in Sweden: A comparison of attitudes between psychodynamic, cognitive, cognitive–behavioral, and integrative therapists.

[Correction Notice: An erratum for this article was reported in Vol 19(3) of Journal of Psychotherapy Integration (see record 2009-16521-006). The results of the post hoc tests were printed illegibly. In order to make it possible for the reader to understand which of the effect sizes belong to which of the comparisons, the tables are clarified in this erratum.] This study focuses on similarities and differences between Swedish psychotherapists of four orientations: psychodynamic, cognitive, cognitive–behavioral, and integrative therapy. The aim is to describe similarities and differences regarding (a) background factors, (b) focus in psychotherapy, (c) attitudes toward psychotherapy as art/craftsmanship, (d) scientific outlook, (e) what characterizes a good psychotherapist, and (f) how psychotherapy ought to be pursued. The therapists had very similar attitudes about the therapeutic relationship and rather similar attitudes about which effects psychotherapy ought to obtain. The greatest differences were related to psychotherapeutic techniques and science. The results are discussed with emphasis on the distance or proximity between the orientations. The conclusion is that there are differences between psychodynamic psychotherapy compared with cognitive and cognitive–behavioral therapies, which imply difficulties in integrating these orientations. However, the differences between the cognitive and cognitive–behavioral therapists are not of such a magnitude that they necessarily present an obstacle to integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for late-life anxiety.

This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age-linked declines in retrieving orthographic knowledge: Empirical, practical, and theoretical implications.

[Correction Notice: An erratum for this article was reported in Vol 14(1) of Psychology and Aging (see record 2008-09595-001). The article contained an error. In Table 1 on page 652, the values for rated spelling ability at age 20 and at current age were reversed for older and oldest adults. The corrected table is included in the erratum, with values that have been changed in bold.] This study developed and tested a Transmission Deficit hypothesis of how aging affects retrieval of orthographic knowledge. Young, older, and very old adults heard a tape-recorded series of difficult-to-spell words of high and low frequency, spoken slowly, clearly and repeatedly, and wrote down each word at their own pace. With perceptual errors and vocabulary differences factored out, misspellings increased with aging, especially for high-frequency words. In addition, data from a metamemory questionnaire indicated that the oldest adults were aware of their declining ability to spell. These findings were not due to general slowing, educational factors, hours per week spent reading, writing, or solving crossword puzzles, or age-linked declines in monitoring or detecting self-produced errors. However, the results fit Transmission Deficit predictions, and suggested an age-linked decline in retrieval of orthographic knowledge that resembles age-linked declines in spoken word retrieval observed in many other studies. Practical implications of this age-linked decline for conceptions of normal aging are noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Five methods for computing significant individual client change and improvement rates: Support for an individual growth curve approach.

[Correction Notice: An erratum for this article was reported in Vol 70(6) of Journal of Consulting and Clinical Psychology (see record 2007-16954-001). In this article, the values reported for hierarchical linear modeling (HLM) in Table 2 (p. 1046) were incorrect. This erratum provides the correct values and further information on the conclusion of the study.] Interest has been renewed in methods for determining individual client change. Currently, there are at least 4 pretreatment–posttreatment (pre-post) difference score methods. A 5th method, based on a random effects model and multiwave data, represents a growth curve approach and was hypothesized to be more sensitive to detecting significant (p?p?     

Factors in the Self-Deception Questionnaire: Associations with depression.

[Correction Notice: An erratum for this article was reported in Vol 48(6) of Journal of Personality and Social Psychology (see record 2008-10977-001). Errors appear in Table 2 on page 247. The factor loading for Item 7 (.65) is listed under Factor 2 and it should be under Factor 4. The factor loading for Item 18 (.54) is listed under Factor 2 and it should be under Factor 3.] Administered the Self-Deception Questionnaire (SDQ) and the Beck Depression Inventory (BDI) to 60 male and 52 female undergraduates and replicated the negative correlation found by H. A. Sackeim and R. C. Gur (1978; see also PA, Vol 62:6213). The SDQ was factor analyzed to determine which factors might account for this correlation with depression. Analysis showed that the 3 largest factors, identified by content themes of relationship with parents, emotionality, and denial of tabooed activities, correlated reliably with the BDI. Acceptable conceptualizations of distortion and reality and data that empirically relate those conceptualizations to depression and other forms of psychopathology are needed to clarify any associations that exist between cognitive accuracy and emotional functioning. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The road to forgiveness: A meta-analytic synthesis of its situational and dispositional correlates.

[Correction Notice: An erratum for this article was reported in Vol 137(2) of Psychological Bulletin (see record 2011-03899-006). In Table 2, weighted population correlations and associated standard errors and confidence intervals are incorrectly reported. In Table 3, weighted population correlations and associated confidence intervals are incorrectly reported, as well as the Q statistic for trait forgiveness. Corrected data are presented. The authors note that substantive interpretations of the results are not affected by the corrections. The median absolute value correction for the weighted population correlations in both tables is r = .01.] Forgiveness has received widespread attention among psychologists from social, personality, clinical, developmental, and organizational perspectives alike. Despite great progress, the forgiveness literature has witnessed few attempts at empirical integration. Toward this end, we meta-analyze results from 175 studies and 26,006 participants to examine the correlates of interpersonal forgiveness (i.e., forgiveness of a single offender by a single victim). A tripartite forgiveness typology is proposed, encompassing victims' (a) cognitions, (b) affect, and (c) constraints following offense, with each consisting of situational and dispositional components. We tested hypotheses with respect to 22 distinct constructs, as correlates of forgiveness, that have been measured across different fields within psychology. We also evaluated key sample and study characteristics, including gender, age, time, and methodology as main effects and moderators. Results highlight the multifaceted nature of forgiveness. Variables with particularly notable effects include intent (r? = ?.49), state empathy (r? = .51), apology (r? = .42), and state anger (r? = ?.41). Consistent with previous theory, situational constructs are shown to account for greater variance in forgiveness than victim dispositions, although within-category differences are considerable. Sample and study characteristics yielded negligible effects on forgiveness, despite previous theorizing to the contrary: The effect of gender was nonsignificant (r? = .01), and the effect of age was negligible (r? = .06). Preliminary evidence suggests that methodology may exhibit some moderating effects. Scenario methodologies led to enhanced effects for cognitions; recall methodologies led to enhanced effects for affect. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A meta-analysis of psychotherapy and drug therapy in the treatment of unipolar depression with adults.

Conducted a meta-analysis of 56 outcome studies of psychotherapy and drug therapy in the treatment of unipolar depression in adults. Five types of psychotherapy were examined: behavioral; social learning-interpersonal; cognitive; a combination of cognitive, social learning, and behavioral; and marital. 35 types of drug therapy were examined; the 2 most common were imipramine and amitriptyline. Findings suggest that psychotherapy (mean effect size 1.22) was superior to drug therapy (mean effect size .61) in treating unipolar depression. This finding is discussed in relation to the relative strengths and weaknesses of narrative vs qualitative approaches to synthesizing the findings of many studies. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of satisfaction to symptom change, follow-up adjustment, and clinical significance.

The relationship of client satisfaction to outcome was investigated for adult outpatients (N? = ?152) from 3 urban community mental health centers. Clients completed a problem self-rating and the Brief Symptom Inventory (BSI) at intake, 10 weeks later, and 5 months later. Therapists' ratings of client adjustment were obtained at intake and termination. Clients' ratings of satisfaction with treatment were obtained at 10-week and 5-month follow-up. Correlations between satisfaction and client measures of outcome (client rating and BSI) based on pre-post changes, posttreatment adjustment, and Jacobson and Truax's (1991) method of measuring clinical significance were not significant. Correlations between satisfaction and therapist outcome ratings were significant but low for pre-post changes and clinical significance. The utility of client satisfaction as an outcome measure is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Valvular disease associated with systemic illness

The connective tissue diseases are immune-mediated inflammatory diseases that manifest predominantly with symptoms and signs of musculoskeletal and mucocutaneous inflammation. They frequently affect the heart valves, pericardium, and myocardium. In patients with AKS, the aortic root and conduction system are also frequently involved. Echocardiographic series in these patients have demonstrated that valvular disease is highly prevalent and associated with substantial morbidity and mortality (Table 1). The prevalence rates of clinically detected valvular disease, however, are either unknown or low. This discrepancy is related to lack of awareness, overshadowing of the cardiovascular manifestations by the inflammatory symptoms and signs of the musculoskeletal system, lack of systematic application of the history and cardiovascular physical examination, and high sensitivity of echocardiography for detecting subclinical abnormalities. Several valvular abnormalities have been identified as unique to a specific disease. Libman-Sacks vegetations, valve nodules, and subaortic bump are characteristic of SLE, RA, and AKS (see Table 1). The valvular complications and respective therapy are similar to those of other causes of valvular disease; however, the associated morbidity and mortality of these complications in these patients are high. The worse prognosis of valvular disease in these patients is related to the chronicity and debilitating nature of their illness, their high prevalence of multisystem disease, and immunosuppression. These factors underscore the importance of early recognition, prevention of complications, and proper clinical or echocardiographic follow-up. The distinctive echocardiographic characteristics of the valve abnormalities associated with the connective tissue diseases may allow their differentiation from other common valvulopathies, such as infective endocarditis, rheumatic valvular disease, and degenerative valvular disease (Table 2). Despite the clinical and prognostic implications of valvular disease associated with the connective tissue diseases, incomplete data are available about pathogenesis, relation to clinical features of the primary disease, evolution, and effect of steroid or cytotoxic therapy. Echocardiography, especially TEE, has the potential to redefine the prevalence rates and to characterize better the valve abnormalities associated with these conditions. Finally, future large cross-sectional and longitudinal studies using clinical and echocardiographic data may help to define better the presence, evolution, and therapy of the valvular disease associated with the connective tissue diseases.     

Psychological treatment for panic disorder with agoraphobia: A randomized controlled trial to examine the role of therapist-guided exposure in situ in CBT.

[Correction Notice: An erratum for this article was reported in Vol 79(5) of Journal of Consulting and Clinical Psychology (see record 2011-21293-002). In the article, the name of author Georg W. Alpers was misspelled as George W. Alpers. In Table 2, in the footnote, line two, the criteria should read “MI≤1.8”. The online versions of this article have been corrected.] Objective: Cognitive–behavioral therapy (CBT) is a first-line treatment for panic disorder with agoraphobia (PD/AG). Nevertheless, an understanding of its mechanisms and particularly the role of therapist-guided exposure is lacking. This study was aimed to evaluate whether therapist-guided exposure in situ is associated with more pervasive and long-lasting effects than therapist-prescribed exposure in situ. Method: A multicenter randomized controlled trial, in which 369 PD/AG patients were treated and followed up for 6 months. Patients were randomized to 2 manual-based variants of CBT (T+/T?) or a wait-list control group (WL; n = 68) and were treated twice weekly for 12 sessions. CBT variants were identical in content, structure, and length, except for implementation of exposure in situ: In the T+ variant (n = 163), therapists planned and supervised exposure in situ exercises outside the therapy room; in the T? group (n = 138), therapists planned and discussed patients' in situ exposure exercises but did not accompany them. Primary outcome measures were (a) Hamilton Anxiety Scale, (b) Clinical Global Impression, (c) number of panic attacks, and (d) agoraphobic avoidance (Mobility Inventory). Results: For T+ and T? compared with WL, all outcome measures improved significantly with large effect sizes from baseline to post (range = ?0.5 to ?2.5) and from post to follow-up (range = ?0.02 to ?1.0). T+ improved more than T? on the Clinical Global Impression and Mobility Inventory at post and follow-up and had greater reduction in panic attacks during the follow-up period. Reduction in agoraphobic avoidance accelerated after exposure was introduced. A dose–response relation was found for Time × Frequency of Exposure and reduction in agoraphobic avoidance. Conclusions: Therapist-guided exposure is more effective for agoraphobic avoidance, overall functioning, and panic attacks in the follow-up period than is CBT without therapist-guided exposure. Therapist-guided exposure promotes additional therapeutic improvement—possibly mediated by increased physical engagement in feared situations—beyond the effects of a CBT treatment in which exposure is simply instructed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clinical psychologists' judgments of the scientific merit and clinical relevance of psychotherapy outcome research.

In Study 1, clinical psychologists evaluated 1 of 4 psychotherapy studies, each of which varied on 3 methodological characteristics. Psychologists' judgments of the studies' scientific merit were influenced by patient assignment and follow-up but not by the therapists' experience level. Judgments of the studies' clinical relevance were influenced primarily by the patient population, the findings' applicability, and the nature of the therapy provided. In Study 2, psychologists were more critical of the methodology of studies that reported negative findings than they were of studies that reported positive findings. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy in two-plus-one sessions: Outcomes of a randomized controlled trial of cognitive–behavioral and psychodynamic–interpersonal therapy for subsyndromal depression.

A total of 116 clients with a range of subsyndromal depression received 3 therapy sessions: 2 sessions 1 week apart followed by a 3rd session 3 months later (the 2?+?1 model). Clients were stratified for severity on the Beck Depression Inventory (BDI) as stressed, subclinical, or low-level clinically depressed. In a 2?×?2 design, they received either cognitive–behavioral (CB) or psychodynamic–interpersonal (PI) therapy, either immediately or after a 4-week delay. An initial advantage for the immediate condition disappeared once the delayed-condition clients received treatment. Improvement rates at the end of treatment were 67% (stressed), 72% (subclinical), and 65% (low-level clinically depressed). There were no significant differences between CB and PI treatment methods, with the exception at 1-year follow-up, when the BDI showed a significant advantage for CB. Implications for designing very brief planned interventions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic Engagement With Adolescents in Psychotherapy.

Therapeutic engagement of adolescents is critical to maximizing the success of any psychotherapy intervention. Therapists have found that engaging adolescents is especially challenging and that there are several reasons for this. Most psychotherapy models are based on treatments that work for adults. These methods are frequently not conducive to engaging adolescents because of their developmental immaturity, the stigma many adolescents associate with psychotherapy, and adolescents feeling forced into psychotherapy. Existing empirical and clinical knowledge about therapy process, adolescent development, and adolescent interactions with their social ecology can be used to guide psychotherapists working with this population. Engaging adolescents in psychotherapy and establishing a strong therapeutic alliance with adolescents require that therapists express empathy and genuineness, utilize developmentally appropriate interventions, address the stigma, and increase choice in therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)