Background The definition of psychological treatments and psychotherapy has various implications for communication within research and clinical care, as well as for legal issues — particularly in countries with psychotherapy acts. It can define what should be covered by public healthcare systems and who should be permitted to provide these services. Method We assembled a group of psychotherapists in Germany to develop an inclusive, scientific definition of psychotherapy. This definition should serve as an umbrella that is not limited to traditional treatment schools and is suitable for science, clinical care and legal acts. The group comprised people with different therapeutic backgrounds (e.g., CBT, psychodynamic and systemic therapy), experts from various disciplines (e.g., psychology, psychiatry and psychosomatic medicine), people focusing on different age groups (e.g., adults and youth), individuals with lived experience of psychotherapy and early career clinicians. Results A literature review led us to consider four aspects of a definition. What are the treatment means or 'tools'? (modality of treatment); how does the treatment work? (Proposed change mechanisms, assumptions about causal and evidence-based processes and concepts); who receives psychotherapy? (target group); and who provides psychotherapy? (Provider). Based on these aspects, we offer a definition of psychological therapy. Discussion Our suggested definition is not bound to specific treatment orientations, but is intended to encompass both traditional approaches and innovative developments. Our aim is to promote the evidence-based provision of psychological therapy within healthcare systems and legal frameworks.
Background Elevated paranoia levels have been found in discriminated, minoritized groups. Social-cognitive models of paranoia posit that experiences of discrimination strengthen negative core beliefs, which in turn foster clinical paranoia. In contrast, the healthy cultural mistrust hypothesis proposes that elevated paranoia in minoritized groups reflects an adaptive response to increased exploitation/discrimination. To explore whether elevated paranoia in discriminated groups can be fully understood within clinical models, we tested whether a history of discrimination amplifies the association between everyday-life stressors and subsequent state-paranoia and whether this moderation effect remains when controlling for established cognitive risk factors for paranoia (i.e., dysfunctional beliefs). Method A general population sample ( n = 108) answered a baseline self-report questionnaire of lifetime discrimination experiences (LDE) and core beliefs about oneself and others. Next, they reported state-paranoia, negative affect, and exclusion experiences in 2.5h intervals for seven days of ambulatory assessment. LDE and core-beliefs were tested as concurrent moderators for the associations between state-paranoia and putative triggers (negative-affect, exclusion) using multilevel regression. Results More LDE amplified the association between paranoia, negative affect, and exclusion experiences. When controlling for the moderation effects of negative beliefs, effect sizes for the LDE moderation were lower but largely remained significant. Conclusions Increased state-paranoia in the daily lives of people with discrimination experiences can be partially, but not fully, explained by clinical, cognitive risk factors. Consequently, healthy cultural mistrust can be considered an additional contributing factor to higher mistrust/paranoia in minoritized groups. Future in-depth research needs to disentangle mechanisms of emerging paranoia and adaptive mistrust in minoritized groups.
Background Research demonstrates that mental disorders are associated with specific dysfunctional expectations and a reduced ability to adjust them, even after expectation-violating experiences. The ViolEx (violated expectation) model offers a framework to explain why expectations persist or change, introducing the concept of cognitive immunization as a potential explanation for differences in information processes. Expectation-focused psychological interventions (EFPI) aim to promote expectation adaptation. Method This study examines the effectiveness of an online EFPI platform for individuals with mild depressive and/or anxiety symptoms. A total of 128 participants, screened with the PHQ-9 (scores 5-9) and/or BAI (scores 8-25), were randomly assigned to one of three groups. The EFPI group and the active control group (ACG) received a psychoeducational video about expectations and their influence on behavior. Over four weeks, the EFPI group completed behavioral experiments to test their personal expectations, while the ACG used only cognitive strategies to challenge personal expectations. A third group (control group; CG) received no intervention. Surveys were administered at baseline, four weeks, and eight weeks after the initial assessment. Results A significant reduction in cognitive immunization was observed over measurement timepoints, with a significant difference to the CG at the follow-up. Anxiety symptoms appear to moderate this effect, whereas EFPI did not influence depressive symptoms, nor did depressive symptoms moderate changes in cognitive immunization. Conclusion This study is the first to evaluate online EFPI for mild depression and/or anxiety symptoms, suggesting that EFPI may reduce cognitive immunization. Future studies should investigate therapist-delivered EFPI in clinical populations with more severe symptoms.
Background By identifying predictors of treatment failure that are susceptible to change (amenable), we can move towards studying ways to decrease the odds of treatment failure, e.g., by targeting these predictors before treatment, adapting interventions, accordingly, choosing more suitable treatments, or preparing patients better for psychotherapy. While treatment success, within anxiety and depressive disorders, has been studied extensively, it seems that treatment failure is overlooked, even while we know that about one third of the treatment population shows no benefit in treatment. Method In order to review the available body of knowledge concerning amenable patient-specific predictors for treatment failure, we conducted a literature search in PubMed, PsycInfo, Embase, and Medline, following the Prisma-ScR guidelines. Thirty articles met the inclusion criteria and are summarized in this review. Conclusions were drawn for scientific and clinical implications. Results Predictors of treatment failure that are replicated or are significant in multiple studies are low treatment expectancy, high neuroticism, low use of social support, low outcome expectancy, and low perceived social support. Treatment failure is hard to define, and very few studies are replicated. There are predictors that are studied in multiple articles, but they are measured with different instruments, or in very small or specific patient samples, therefore it is difficult to compare findings from different studies. Conclusions There are no predictors that stand out as overall strong amenable predictors of treatment failure. Possible predictors are high neuroticism, low treatment expectancies, and low use of social support. Future research should focus on replicating studies to confirm these predictors of treatment failure.
Background: Prolonged Grief Disorder (PGD) was included in the DSM-5-TR and ICD-11. The Traumatic Grief Inventory Self-Report Plus (TGI-SR+) is a self-report measure to assess PGD symptoms in accordance with both classification systems. It has been translated into various languages and validated across different contexts. Objective: Evaluating the psychometric properties of the Ukrainian TGI-SR+. Method: Participants were Ukrainian adults who had lost a loved one at least 6 months ago. One hundred ninety-eight participants completed the TGI-SR+ and measures assessing posttraumatic stress and depression. We examined the factor structure, internal consistency, convergent validity, and known-groups validity of the TGI-SR+. Moreover, rates of probable PGD caseness were calculated, and provisional cut-off scores were determined based on Receiver Operating Characteristic (ROC) analyses. Results: The one-factor model showed an acceptable fit for DSM-5-TR, but not for ICD-11 PGD symptoms. While some of the factor loadings were low for both criteria sets, the items demonstrated good internal consistency. Convergent validity was supported by strong associations between symptom levels of DSM-5-TR and ICD-11 PGD and posttraumatic stress and depression severity scores. Known-groups validity was partially supported by DSM-5-TR and ICD-11 PGD severity being related to both cause of death and kinship to the deceased. The provisional cut-off score for detecting both probable DSM-5-TR and ICD-11 PGD caseness, when summing all TGI-SR+ items, was >= 75. Conclusion: The psychometric properties of the Ukrainian TGI-SR+ were mixed. However, pending further research in different and larger samples of Ukrainian bereaved people, this instrument can be used to assess PGD severity in Ukrainians.
