Therapist Interventions and Skills as Predictors of Dropout in Outpatient Psychotherapy

The current study employed machine learning to investigate whether the inclusion of observer-rated therapist interventions and skills in early sessions of psychotherapy improved dropout prediction beyond intake assessments. Patients were treated by postgraduate clinicians at a university outpatient clinic. Psychometric instruments were assessed at intake and therapeutic interventions and skills in the third session were routinely rated by independent observers. After variable preselection, an elastic net algorithm was used to build two dropout prediction models, one including and one excluding observer-rated session variables. The best model included observer-rated variables and was significantly superior to the model including intake variables only. Alongside intake variables, two observer-rated variables significantly predicted dropout: therapist use of feedback and summaries and treatment difficulty. Although not retained in the final prediction model, the observer-rated use of cognitive techniques was also significantly correlated with dropout. Observer ratings of therapist interventions and skills in early sessions of psychotherapy improve predictors of dropout from psychotherapy beyond intake variables alone. Future research could work toward personalizing dropout predictions to the specific dyad, thereby improving their validity and aiding therapists to recognize and react to increased dropout risk.     

Homework Compliance and Quality in Cognitive Behavioral Therapies for Anxiety Disorders and Obsessive-Compulsive Disorder

Homework assignments are an integral part of cognitive behavioral therapy, providing patients with opportunities to practice skills between sessions. Generally, greater homework compliance is associated with better treatment outcomes. However, fewer studies have examined the effect of homework quality on treatment outcomes. This study examined homework compliance and quality as predictors of outcome and attrition across five CBT protocols. A sample of 179 individuals with principal diagnoses of generalized anxiety disorder, panic disorder, social anxiety disorder, or obsessive-compulsive disorder were randomized to receive a transdiagnostic CBT protocol (the Unified Protocol) or a single-diagnosis CBT protocol corresponding to their principal diagnosis. The Unified Protocol had a lower homework burden than the majority of the single-diagnosis protocols, which varied in degree of assigned homework. Despite this, there were no differences in average homework compliance or quality across principal diagnosis, treatment condition, or their interaction. Homework quality was significantly related to all symptom outcomes (self-reported and clinician-rated anxiety and depressive symptoms, clinician-rated clinical severity). Homework compliance was significantly related to clinician-rated anxiety symptom outcomes. Additionally, greater homework quality and compliance were both significantly associated with increased odds of completing treatment, suggesting homework variables can be useful and easily obtainable predictors of treatment retention.     

Infant speech perception and cognitive skills as predictors of later vocabulary

Research has identified bivariate correlations between speech perception and cognitive measures gathered during infancy as well as correlations between these individual measures and later language outcomes. However, these correlations have not all been explored together in prospective longitudinal studies. The goal of the current research was to compare how early speech perception and cognitive skills predict later language outcomes using a within-participant design. To achieve this goal, we tested 97 5- to 7-month-olds on two speech perception tasks (stress pattern preference, native vowel discrimination) and two cognitive tasks (visual recognition memory, A-not-B) and later assessed their vocabulary outcomes at 18 and 24 months. Frequentist statistical analyses showed that only native vowel discrimination significantly predicted vocabulary. However, Bayesian analyses suggested that evidence was ambiguous between null and alternative hypotheses for all infant predictors. These results highlight the importance of recognizing and addressing challenges related to infant data collection, interpretation, and replication in the developmental field, a roadblock in our route to understanding the contribution of domain-specific and domain-general skills for language acquisition. Future methodological development and research along similar lines is encouraged to assess individual differences in infant speech perception and cognitive skills and their predictability for language development.     

Learning a Phonological Contrast Modulates the Auditory Grouping of Rhythm

Perceptual grouping is fundamental to many auditory processes. The Iambic–Trochaic Law (ITL) is a default grouping strategy, where rhythmic alternations of duration are perceived iambically (weak‐strong), while alternations of intensity are perceived trochaically (strong‐weak). Some argue that the ITL is experience dependent. For instance, French speakers follow the ITL, but not as consistently as German speakers. We hypothesized that learning about prosodic patterns, like word stress, modulates this rhythmic grouping. We tested this idea by training French adults on a German‐like stress contrast. Individuals who showed better phonological learning had more ITL‐like grouping, particularly over duration cues. In a non‐phonological condition, French adults were trained using identical stimuli, but they learned to attend to acoustic variation that was not linguistic. Here, no learning effects were observed. Results thus suggest that phonological learning can modulate low‐level auditory grouping phenomena, but it is constrained by the ability of individuals to learn from short‐term training.     

Efficacy of Dialectical Behavior Therapy for Adolescents in a Partial Hospitalization Program

This study evaluated dialectical behavior therapy for adolescents (DBT‐A) vs. treatment as usual within a 6‐week partial hospitalization program. The 103 adolescent participants (mean age = 15.27 years) were predominantly girls (n = 63, 61%) with a variety of primary mental health diagnoses. Results indicated that DBT‐A was superior for decreasing symptoms of depression and interpersonal sensitivity, but no statistically significant difference was detected for anxiety or hostility. Implications for treating youth with transdiagnostic identities are discussed.     

Transgender and Gender Diverse Patients in Intensive Mood Disorder Treatment: A Comparative Examination of Clinical Presentation and Treatment Outcomes

Individuals who are transgender and gender diverse (TGD) are more likely to suffer from and to seek mental health services for mood disorders. Some literature suggests that TGD individuals, because of pervasive and systemic minority stress, may have more complex clinical presentations (i.e., psychiatric conditions and severity of symptoms) and may benefit from empirically based treatments to a lesser degree than their cisgender peers. However, research has yet to examine individuals who are TGD receiving treatment in specialized, intensive mood disorder treatment despite the propensity for them to be diagnosed with and treated for mood disorders. Using a sample of 1,326 adult patients in intensive mood disorder treatment (3.8% TGD), the clinical presentation and treatment outcomes were compared between patients who are TGD and cisgender. Contrary to previous research, TGD patients were largely similar if not healthier than their cisgender counterparts, including similar depression severity, quality of life, emotion dysregulation, and behavioral activation, and less severe rumination at admission. Despite similar to better reported mental health symptoms, TGD patients were diagnosed with more psychiatric conditions overall, including greater prevalence of social anxiety and neurodevelopmental diagnoses. Those who are TGD did not experience attenuated treatment response as predicted. Findings suggest that patients in intensive mood disorder treatment who are TGD may be more resilient than previously assumed, or supports may have increased to buffer effects of stigma on mental health, and emphasize the need to exercise discretion and sensitivity in diagnostic practices to prevent over-diagnosis and pathologizing of TGD individuals.     

Therapists’ Thought-Action Fusion Beliefs Predict Utilization of Exposure in Obsessive-Compulsive Disorder

Although exposure and response prevention (ERP) is considered the gold standard for the treatment of obsessive-compulsive disorder (OCD), it is rarely used in clinical practice. Therapists’ beliefs about ERP affect its utilization, as previous research suggests, but the role of therapists’ cognitive biases is unclear. In particular, susceptibility to thought-action fusion (TAF) may be related to the underutilization of ERP in OCD.Therapists (N = 353) were divided into those recommending (ERP+, n = 228) and not recommending ERP (ERP−, n = 125) as treatment for an OCD case example. TAF in therapists was assessed using behavioral and self-report measures (TAFS).TAF was higher in the ERP− than the ERP+ group, with a small to moderate effect size (0.2 ≤ d ≤ 0.4). ERP− therapists showed more avoidance and neutralizing behavior and a stronger emotional response than the ERP+ therapists during the experimental task. Moreover, higher TAF as measured by the TAFS was associated at a small magnitude with lower likelihood of using ERP in the therapists’ actual clinical practices.Therapists’ cognitive biases should be addressed in their training in order to increase the dissemination of evidence-based treatment (i.e., ERP) and thus improve the treatment of OCD.     

Building a Theoretical Model for Supporting Teens’ Autonomy Daily (STAND): A Network Analysis of Family-Perceived Changes

Little is known about processes through which behavior therapy (BT) for adolescent ADHD improves outcomes. The purpose of this study was to build a theoretical model for the processes through which a BT for adolescent ADHD (Supporting Teens’ Autonomy Daily; STAND) impacts functioning. Seventy-eight audio recordings from a standard therapeutic task in the final STAND session were analyzed as parents and adolescents (ages 11–16) reflected upon what changed during STAND and why. Qualitative coding sorted parent and teen statements into orthogonal categories of perceived changes. Network analysis examined inter-relations between categories. Results indicated twenty-one categories of perceived change areas. Parent use of behavioral strategies, adolescent motivation, and adolescent organization skills were central nodes in the network of perceived changes, with strong relations to academic and parent-teen relationship outcomes. A model is proposed in which skills training in STAND increases parent behavioral strategy use and teen organization skills, while Motivational Interviewing (MI) in STAND increase parent behavioral strategy use and initial adolescent motivation. In turn, parent behavioral strategy use is proposed to further reinforce teen motivation through contingency management, thereby increasing teen application of organization skills to daily life. As a result of improved teen motivation and organization skills, the model proposes that ADHD symptoms, academic problems, and parent-teen conflict abate. We discuss secondary mechanisms and outcomes in this model, the possibility of person-specific processes, implications for community-based adaptation of STAND, and plans to validate this conceptual model using sophisticated mediational models.     

Intolerance of Uncertainty and Perfectionistic Beliefs About Parenting as Cognitive Mechanisms of Symptom Change During Cognitive Behavior Therapy for Perinatal Anxiety

ObjectiveA recent randomized controlled trial of group cognitive behavior therapy (CBGT) for perinatal anxiety showed that CBGT is effective in reducing anxiety and depression in pregnant and postpartum women. In secondary analyses, the role of potential mechanisms of symptom change was examined, including intolerance of uncertainty (IU), self-oriented parenting perfectionism (SOPP) and societal-prescribed parenting perfectionism (SPPP).MethodThe sample included 75 women (M_age = 31.99, SD = 3.57; 37.3% pregnant, 62.7% postpartum) who sought treatment for anxiety and completed the 6-week CBGT or 6-week waitlist within the larger trial. Measures of anxiety (State-Trait Inventory for Cognitive and Somatic Anxiety; STICSA), depression (Edinburgh Postnatal Depression Scale; EPDS), and the proposed mediators (IU, SOPP, SPPP) were completed at baseline and 6-weeks post-baseline.ResultsTwo moderated mediation models were evaluated to identify potential mediators of the effect of condition (CBGT, waitlist) on anxiety (STICSA; Model 1) or depressive symptoms (EPDS; Model 2). In Model 1, changes in IU partially mediated the effect of condition on anxiety (STICSA) for both pregnant and postpartum women. Changes in SOPP and SPPP were partial mediators for postpartum women only. Change in depression (EPDS) was also a partial mediator for pregnant women in this model. In Model 2, none of the cognitive variables mediated the effect of condition on depressive symptoms (EPDS). However, change in anxiety (STICSA) was a significant mediator of the effect of condition on depression (EPDS) and only among pregnant women.ConclusionsThe results provide support for IU, SOPP and SPPP as mechanisms of change during CBGT and identify differences in important mechanisms among pregnant and postpartum women.