Many community mental health centers have implemented peer treatment models that employ recovered former clients as cost-efficient adjunct providers. The effectiveness of these and other peer-administered interventions (PAIs) for treating depression symptoms has not been well-established. The current study is a meta-analysis of PAIs' effects on depression symptoms. Twenty-three eligible studies were identified. Study characteristics were coded by multiple raters, random-effects models were used to compare mean effect sizes, and mixed-effects models were used to test for moderation. PAIs produced significant pre-post reductions in depression symptoms (d = .5043 [95 % CI .3675-.6412]). In direct comparisons, PAIs performed as well as non-peer-administered interventions (.0848 [-.1455-.3151]), and significantly better than no-treatment conditions (.2011 [.0104-.3918]). PAIs that involved a professional in a secondary treatment role were significantly less effective than those that were purely peer-administered, and educational/skills-based PAIs produced better outcomes than those that were mainly supportive. Follow-up data, when available, indicated that PAIs' benefits were maintained. PAIs reduce depression symptoms and warrant further study. The clinical significance of PAIs' benefits, and whether they are better suited as stand-alone or adjunct treatments, remain to be established. Implications for the roles of mental health professionals are discussed.

Many community mental health centers have implemented peer treatment models that employ recovered former clients as cost-efficient adjunct providers. The effectiveness of these and other peer-administered interventions (PAIs) for treating depression symptoms has not been well-established. The current study is a meta-analysis of PAIs’ effects on depression symptoms. Twenty-three eligible studies were identified. Study characteristics were coded by multiple raters, random-effects models were used to compare mean effect sizes, and mixed-effects models were used to test for moderation. PAIs produced significant pre-post reductions in depression symptoms ( d = .5043 [95 % CI .3675–.6412]). In direct comparisons, PAIs performed as well as non-peer-administered interventions (.0848 [−.1455–.3151]), and significantly better than no-treatment conditions (.2011 [.0104–.3918]). PAIs that involved a professional in a secondary treatment role were significantly less effective than those that were purely peer-administered, and educational/skills-based PAIs produced better outcomes than those that were mainly supportive. Follow-up data, when available, indicated that PAIs’ benefits were maintained. PAIs reduce depression symptoms and warrant further study. The clinical significance of PAIs’ benefits, and whether they are better suited as stand-alone or adjunct treatments, remain to be established. Implications for the roles of mental health professionals are discussed.

Little is known about factors differentiating more and less effective therapists or the mechanisms through which therapists influence outcome. In the present study, the performance of a small sample of 4 therapists was compared in the context of delivering cognitive-behavioral psychotherapy (CBT) to 32 clients with generalized anxiety disorder. More effective therapists were characterized by higher observer-rated CBT competence, higher client outcome expectations and client treatment credibility assessments, and higher early treatment client ratings of therapeutic alliance quality. Higher early CBT competence was associated with higher client midtreatment outcome expectations, which in turn were associated with better posttreatment outcomes. Although these findings are preliminary given the small sample of therapists and clients, they suggest that the common factor of outcome expectations might be a mechanism through which the specific factor of psychotherapist competence exerts its influence on treatment outcome. The implications of these findings and directions for future research are discussed.

UNLABELLED:Self-criticism plays a key role in many psychological disorders and predicts poor outcome in psychotherapy. Yet, psychotherapy research directly targeting self-critical processes is limited. In this pilot study, we examined the efficacy of an emotion-focused intervention, the two-chair dialogue task, on self-criticism, self-compassion and the ability to self-reassure in times of stress, as well as on depressive and anxiety symptoms among nine self-critical clients. Results showed that the intervention was associated with significant increases in self-compassion and self-reassuring, and significant reductions in self-criticism, depressive symptoms and anxiety symptoms. Effect sizes were medium to large, with most clients exhibiting low and non-clinical levels of symptomatology at the end of therapy, and maintaining gains over a 6-month follow-up period. Although preliminary, these finding suggest that emotion-focused chair work might be a promising intervention addressing self-criticism.KEY PRACTITIONER MESSAGE:Self-criticism is an important process in a variety of clinical disorders and predicts poor outcome in brief therapy for depression. Yet, little is known about how self-criticism can be effectively addressed in psychological treatment. Practitioners can benefit from increasing their awareness of self-critical processes in their clinical work, and from directly working with emotions in addressing self-criticisim. Emotion-focused two-chair dialogue intervention can be effective in reducing self-criticism, increasing self-compassion, and decreasing depressive and anxiety symptoms, and these improvements are largely maintained six months after therapy.

Clinical and research applications of motivational interviewing (MI) have grown at a remarkable pace over the past 25 years. Most of this work has targeted the addictions and health-related behaviors. The series of articles in this issue highlight a rapidly accelerating recent trend: the application of MI to other problems typically seen in clinical practice. This introductory article describes MI, its core principles, treatment methods, and the variety of ways in which it has been employed. The 6 case reports in this issue are then described. They illustrate how MI can be employed with generalized anxiety, adolescent depression, lifestyle changes, social anxiety disorder, suicidality, and intimate partner violence. The series of articles in this issue concludes with a commentary on the cases and a practice-friendly review of outcome research on MI.

Seventy-six individuals with a principal diagnosis of generalized anxiety disorder (GAD) were randomly assigned to receive either an MI pretreatment or no pretreatment (NPT), prior to receiving CBT. Significant group differences favoring the MI-CBT group were observed on the hallmark GAD symptom of worry and on therapist-rated homework compliance, which mediated the impact of treatment group on worry reduction. Adding MI pretreatment to CBT was specifically and substantively beneficial for individuals with high worry severity at baseline. There was evidence of relapse at 6-month follow-up for high severity individuals who received MI-CBT, but significant moderator effects favoring the high severity MI-CBT group were again apparent at 12-months post-treatment. Pending replication in a more controlled test, these findings suggest that MI may be a promising adjunct to CBT for GAD for those of high severity, a group which has been less responsive to CBT in past research.

Over the past 30 years, the topic of psychotherapy integration has moved from a latent theme to a clear movement, and the commentaries made in this issue of Applied and Preventive Psychology document these changes. More than ever before, the field of psychotherapy has become increasingly interested in achieving a consensus. The question is becoming what, not who is correct. We are now better able to identify stages of change that cut across different orientations, as well as underlying principles of change. Still, we are not “there yet,” and need to confront the limitations stemming from an overvaluation of what is “new,” and to develop a common language with which to communicate what we know. It is also suggested that a two-way bridge between research and practice can represent the future of psychotherapy integration.

Resistance to change is a problem that has long evaded easy solutions. In this article, the authors suggest the value of understanding and working with some forms of resistance as ambivalence. They describe resistant ambivalence in the context of an integrative and multivoiced understanding. A person who is ambivalent possesses a voice that moves toward change and a voice that struggles against change. The authors sought therapy methods that were consistent with the multivoiced integrative understanding of ambivalence and that could be useful in its resolution. Motivational interviewing and the two-chair method are described in this article, along with illustrative case material. These methods share a common spirit and therapist style that is accepting of the client's worldview and creates a strong partnership between the therapist and client. These methods can be used in conjunction with other therapy approaches and have a research base supporting their use.

Self-administered treatments (SATs) are widely used by the general public and mental health professionals. Previous reviews of the efficacy of SATs have included under this category interventions for nonclinical problems, group interventions, and interventions involving significant amounts of therapist contact. The efficacy of SATs for clinical levels of depression and anxiety with minimal therapeutic contact was examined by meta-analyzing 24 studies, The results show large effects for SATs when compared with no-treatment control groups (d = 1.00). However, unlike previous meta-analyses that found nonsignificant differences between SATs and therapist-administered treatments, in this sample SATs resulted in significantly poorer outcomes (d = -0.31). Some differences in effect size were observed between the clinical targets of depression and anxiety. However, there were high correlations between clinical target, methodological quality of the study, and amount of contact. This makes it impossible to determine whether the observed differences could be explained by the nature of the disorders, methodological quality, or the amount of contact with a member of the research team. The implications of the findings for the clinical use of SATs and for future research are discussed.

Many clients engaging in Cognitive Behavioral Therapy (CBT) for depression and anxiety are ambivalent about change, and about taking necessary actions to bring about change such as exposure or behavioral activation exercises. Given the focus of motivational interviewing (MI) on enhancing readiness for change, it is of great interest to investigate applications of MI to prevalent disorders such as depression and anxiety. After exploring the rationale for integrating MI with CBT for these disorders, we outline unique features of MI that may render it a useful complement to CBT, such as its focus on resolving ambivalence for change and specific strategies for responding to resistance. We suggest several possible ways in which MI may be combined with CBT. Finally, we discuss our clinical experience with adapting MI to the treatment of depression and anxiety, including case illustrations of each, and discuss some of the unique issues arising in generalizing MI for use with these populations.

A meta-analysis was conducted on controlled clinical trials investigating adaptations of motivational interviewing (AMIs), a promising approach to treating problem behaviors. AMIs were equivalent to other active treatments and yielded moderate effects (from .25 to .57) compared with no treatment and/or placebo for problems involving alcohol, drugs, and diet and exercise. Results did not support the efficacy of AMIs for smoking or HIV-risk behaviors. AMIs showed clinical impact, with 51% improvement rates, a 56% reduction in client drinking, and moderate effect sizes on social impact measures (d=0.47). Potential moderators (comparative dose, AMI format, and problem area) were identified using both homogeneity analyses and exploratory multiple regression. Results are compared with other review results and suggestions for future research are offered.

This article presents an integrative perspective on resistance. The phenomena of resistance can be seen at the behavioral, interpersonal, cognitive, and affective levels. A set of integrative working assumptions is proposed in which resistance reflects meaningful information about clients' conflicts among various aspects of their selves relating to change. In this view, resistance is determined by intrapersonal and interpersonal factors and can occur with or without conscious awareness. Integrative approaches to working with these conflicts are described.

Journal of the History of the Behavioral SciencesVolume 38, Issue 1 p. 57-60 Article The Brown University Psychololgy Department, spring 1941 An historic photograph Hal Arkowitz, Hal Arkowitz associate professor of psychology University of ArizonaSearch for more papers by this authorNeil Bartlett, Neil Bartlett professor of psychology emeritus University of ArizonaSearch for more papers by this author Hal Arkowitz, Hal Arkowitz associate professor of psychology University of ArizonaSearch for more papers by this authorNeil Bartlett, Neil Bartlett professor of psychology emeritus University of ArizonaSearch for more papers by this author First published: 31 January 2002 https://doi.org/10.1002/jhbs.1097AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Volume38, Issue1Winter 2002Pages 57-60 RelatedInformation

In this article, resistance is looked at in an integrative way that attempts to abstract and synthesize the main assumptions made by the different therapy approaches. The phenomena of resistance can be seen at the behavioral, interpersonal, cognitive, and affective levels. A set of integrative working assumptions are proposed in which resistance reflects meaningful information about clients' conflicts among various aspects of themselves relating to change. In addition to this intrapersonal perspective, resistance is also seen as determined by interpersonal factors, and can occur with or without conscious awareness. Integrative approaches to working with these conflicts are described. © 1996 John Wiley & Sons, Inc.