For whom should psychotherapy focus on problem coping? A machine learning algorithm for treatment personalization.

OBJECTIVE: We aimed to develop and test an algorithm for individual patient predictions of problem coping experiences (PCE) (i.e., patients' understanding and ability to deal with their problems) effects in cognitive-behavioral therapy. Method: In an outpatient sample with a variety of diagnoses (n=1010), we conducted Dynamic Structural Equation Modelling to estimate within-patient cross-lagged PCE effects on outcome during the first ten sessions. In a randomly selected training sample (2/3 of the cases), we tried different machine learning algorithms (i.e., ridge regression, LASSO, elastic net, and random forest) to predict PCE effects (i.e., the degree to which PCE was a time-lagged predictor of symptoms), using baseline demographic, diagnostic, and clinically-relevant patient features. Then, we validated the best algorithm on a test sample (1/3 of the cases). RESULTS: The random forest algorithm performed best, explaining 14.7% of PCE effects variance in the training set. The results remained stable in the test set, explaining 15.4% of PCE effects variance. CONCLUSIONS: The results show the suitability to perform individual predictions of process effects, based on patients' initial information. If the results are replicated, the algorithm might have the potential to be implemented in clinical practice by integrating it into monitoring and therapist feedback systems.

Effectiveness of Counseling Based on Functional Analytic Psychotherapy with Enhanced Cognitive Therapy on the Sexual Quality of Life of Married Adolescent Women / Eficácia do aconselhamento baseado em psicoterapia analítica funcional - Com abordagem de terapia cognitiva aprimorada (FECT) na qualidade de vida sexual de mulheres adolescentes casadas

Abstract Objective Early marriage has many deleterious effects on the health of girls, such as sexual dissatisfaction, an inevitable result of the lack of sufficient knowledge about sexual issues at the time of the marriage. The goal of the present study was to determine the effectiveness of counseling based on functional analytic psychotherapy with enhanced cognitive therapy (FECT) on the sexual quality of life of married adolescent women. Methods This clinical trial was conducted between July and October 2019 on 150 married adolescent women who met the inclusion criteria. In the intervention group, FECTwas conducted in sixteen 90-minute sessions twice a week. The Sexual Quality of Life-Female (SQOL-F) questionnaire was used. When the study ended, the control group was given the choice of receiving the same intervention as the intervention group. Results The paired t-test showed a significant difference between the mean score of sexual quality of life before (52.33±23.09) and after (88.08±10.51) counseling in the intervention group (p<0.0001). According to the analysis of covariance, there was a significant difference between the score on sexual quality after counseling between the intervention (88.08±10.51) and control (60.32±23.73) groups (p<0.0001). There was also a significant difference between the mean score on the four dimensions of sexual quality of life in the intervention group (p<0.0001). Conclusion The results showed that counseling based on FECT improved the sexual quality of life in all dimensions in married adolescent women.

Resumo Objetivo O casamento precoce tem muitos efeitos deletérios sobre a saúde das meninas, como a insatisfação sexual, resultado inevitável da falta de conhecimento suficiente sobre questões sexuais no momento do casamento. O objetivo do presente estudo foi determinar a eficácia do aconselhamento baseado em psicoterapia analítica funcional com terapia cognitiva aprimorada (FECT) na qualidade de vida sexual de mulheres adolescentes casadas. Métodos Este ensaio clínico foi realizado entre julho e outubro de 2019 em 150 mulheres adolescentes casadas que preencheram os critérios de inclusão. No grupo de intervenção, FECT foi realizado em dezesseis sessões de 90 minutos duas vezes por semana. Foi utilizado o questionário Sexual Quality of Life-Female (SQOL-F). Quando o estudo terminou o grupo de controle teve a opção de receber a mesma intervenção do grupo de intervenção. Resultados O teste t pareado mostrou diferença significativa entre o escore médio da qualidade de vida sexual antes (52,33±23,09) e após (88,08±10,51) o aconselhamento no grupo intervenção (p<0,0001). De acordo com a análise de covariância houve diferença significativa entre o escore de qualidade sexual após aconselhamento entre os grupos intervenção (88,08±10,51) e controle (60,32±23,73) (p<0,0001). Também houve diferença significativa entre a pontuação média nas quatro dimensões da qualidade de vida sexual no grupo de intervenção (p<0,0001). Conclusão Os resultados mostraram que o aconselhamento baseado no FECT melhorou a qualidade de vida sexual em todas as dimensões em mulheres adolescentes casadas.

Patient baseline interpersonal problems as moderators of outcome in two psychotherapies for bulimia nervosa.

Objective: We tested an aptitude by treatment interaction; namely, whether patients' baseline interpersonal problems moderated the comparative efficacy of cognitive-behavioral therapy (CBT) vs. interpersonal psychotherapy (IPT) for bulimia nervosa (BN). Method: Data derived from a randomized-controlled trial. Patients reported on their interpersonal problems at baseline; purge frequency at baseline, midtreatment, and posttreatment; and global eating disorder severity at baseline and posttreatment. We estimated the rate of change in purge frequency across therapy, and the likelihood of attaining clinically meaningful improvement (recovery) in global eating disorder severity by posttreatment. We then tested the interpersonal problem by treatment interactions as predictors of both outcomes. Results: Patients with more baseline overly communal/friendly problems showed steeper reduction in likelihood of purging when treated with CBT vs. IPT. Patients with more problems of being under communal/cold had similar reductions in likelihood of purging across both treatments. Patients with more baseline problems of being overly agentic were more likely to recover when treated with IPT vs. CBT, whereas patients with more problems of being under agentic were more likely to recover when treated with CBT vs. IPT. Conclusions: Interpersonal problems related to communion and agency may inform treatment fit among two empirically supported therapies for BN.

A comparative study of the effectiveness of group-based cognitive behavioral therapy and dialectical behavioral therapy in reducing depressive symptoms in Iranian women substance abusers.

Various therapeutic approaches have been used to improve depressive symptoms in substance abusers. In a quasi-experimental study with a pretest-posttest design and experimental and control groups, we examined and compared the effectiveness of two group-based treatment strategies-cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT)-in reducing depressive symptoms among Iranian women substance abusers. The statistical population included all female addict patients who referred to addiction treatment centers of Birjand city in 2015. A sample of 30 subjects were selected through the available sampling method and randomly assigned into experimental (CBT and DBT) and control groups (each group, 10 patients). The data collection instrument was the Beck Depression Inventory (BDI) questionnaire. The patients in the experimental groups were given skills in eight sessions of 90 min. The data were analyzed by the SPSS-19 software by using mean, standard deviation, and percentages at the descriptive level and analysis of covariance (ANCOVA) test at the inferential level. The comparison of the mean depression score before intervention in all the groups showed no significant difference. However, after intervention, the findings showed that both CBT and DBT interventions could reduce the mean scores of depression in women substance abusers, 17.5 ± 3.0 vs 29.3 ± 4.1 (F[1,17] = 51.91, p value < 0.01) and 14.7 ± 1.8 vs 29.3 ± 4.1 (F[1,17] = 106.62, p value < 0.01), respectively, for CBT and DBT. Post-treatment effect sizes were large and did not differ statistically for CBT (ηp2, 0.75) and DBT (ηp2, 0.86). Therefore, this study highlights the importance of CBT and DBT skills training to substance abusers and provides initial evidence of their effectiveness.

A comparative study of the effectiveness of group-based cognitive behavioral therapy and dialectical behavioral therapy in reducing depressive symptoms in Iranian women substance abusers

Various therapeutic approaches have been used to improve depressive symptoms in substance abusers. In a quasi-experimental study with a pretest-posttest design and experimental and control groups, we examined and compared the effectiveness of two group-based treatment strategies­cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT)­in reducing depressive symptoms among Iranian women substance abusers. The statistical population included all female addict patients who referred to addiction treatment centers of Birjand city in 2015. A sample of 30 subjects were selected through the available sampling method and randomly assigned into experimental (CBT and DBT) and control groups (each group, 10 patients). The data collection instrument was the Beck Depression Inventory (BDI) questionnaire. The patients in the experimental groups were given skills in eight sessions of 90 min. The data were analyzed by the SPSS-19 software by using mean, standard deviation, and percentages at the descriptive level and analysis of covariance (ANCOVA) test at the inferential level. The comparison of the mean depression score before intervention in all the groups showed no significant difference. However, after intervention, the findings showed that both CBT and DBT interventions could reduce the mean scores of depression in women substance abusers, 17.5 ± 3.0 vs 29.3 ± 4.1 (F[1,17] = 51.91, p value < 0.01) and 14.7 ± 1.8 vs 29.3 ± 4.1 (F[1,17] = 106.62, p value < 0.01), respectively, for CBT and DBT. Post-treatment effect sizes were large and did not differ statistically for CBT (ηp2, 0.75) and DBT (ηp2, 0.86). Therefore, this study highlights the importance of CBT and DBT skills training to substance abusers and provides initial evidence of their effectiveness.(AU)

The effect of proinflammatory cytokines in Cognitive Behavioral Therapy.

Major depressive disorder (MDD) is a debilitating disorder and its pathophysiology is associated with deregulation of the immune system. We investigated the changes in circulating levels of proinflammatory cytokines (specifically IL-6 and TNF-α) measured by the ELISA kit in two psychotherapeutic interventions for MDD: Narrative Cognitive Therapy (NCT) and Cognitive Behavioral Therapy (CBT). This is a randomized clinical trial including 97 individuals (18 to 29years-old) with MDD. In CBT there was a significant difference in serum levels of IL-6 and TNF-α, therefore indicating that CBT was more effective than NCT on serum levels proinflammatory cytokines.