Psychotherapist factors that patients perceive are associated with treatment failure.

Psychotherapy is a well-established and effective treatment for various psychiatric problems, but a substantial proportion of patients do not benefit from it, and many terminate treatment prematurely. Previous studies suggest that therapist dissatisfaction may play a pivotal role in premature treatment termination. This study, therefore, aimed to investigate therapist factors that may contribute to less-than-optimal results and dropout. Data were collected through a survey of patients (n = 736) with the experience of previous unsuccessful psychotherapy treatments. Based on prior research, the survey covered 13 therapist behaviors and traits, such as being unstructured or unengaged. The most common therapist factor that patients associated with treatment failure was poor assessment/understanding (86.7%), followed by inflexibility (71.7%) and poor knowledge (70.1%). Furthermore, this study identified four novel therapist-related factors: breaking the treatment contract, inappropriate sexual behaviors or comments, using non-conventional methods, and dominating behaviors. Overall, this study highlights the significance of therapist-related factors in premature treatment termination and treatment failure, shedding light on the crucial role therapists play in the therapeutic process. Understanding these factors is essential for improving psychotherapy outcomes and reducing dropout rates. Further investigations are needed to explore the impact of these therapist behaviors on treatment outcomes and to develop strategies for enhancing therapist competencies and skills to foster a more effective therapeutic alliance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychotherapist variables that may lead to treatment failure or termination-A qualitative analysis of patients' perspectives.

A substantial number of patients do not improve from psychotherapy, some even deteriorate, and some terminate treatment prematurely. Identifying therapist variables that may lead to treatment failures from patients' perspectives can inform how psychotherapists can increase effectiveness. Using a semistructured protocol, we interviewed 24 patients who had experienced unsatisfying individual face-to-face psychotherapy within the last 2 years. The study procedures were guided by the consolidated criteria for reporting qualitative research. The manifest content analysis provided 13 subcategories grouped into four categories: (a) psychotherapists' negative traits (inflexible, unengaged, unemphatic, insecure), (b) unprofessionalism (superficial, violating personal boundaries, breaking confidentiality, nontransparent), (c) incompetence (unstructured, poor assessment or understanding, poor knowledge, too passive), and (d) mismatch (therapist-patient mismatch). To reduce the risk of treatment failure, psychotherapists may need a multifaceted set of relational skills, theoretical and technical competence, ethical sensitivity, and engagement. Some of the identified subcategories were complex constructs (e.g., unengaged) that may need time and effort to develop for psychotherapists. Other identified subcategories were obvious inappropriate behaviors in professional psychotherapy (e.g., breaking confidentiality). However, the categories found in this study need further quantitative investigation to assess the validity, frequency, and relative impact on treatment outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

What do users think about Virtual Reality relaxation applications? A mixed methods study of online user reviews using natural language processing.

The advent of affordable Virtual Reality (VR) technology has spurred consumer and commercial interest in VR relaxation applications, which has quickly grown into a popular non-gaming genre on digital marketplaces. While laboratory studies have demonstrated efficacy of VR relaxation for mental health purposes, little is known about how users experience this type of intervention and no study has examined the reception of consumer versions among regular users in everyday life. Studying published user reviews offers a unique window into naturalistic user experiences that complements traditional qualitative methods by circumventing the sampling bias of interview studies, and allowing analyses on full samples, unconstrained by coding resources. Using an innovative, semi-automated Natural Language Processing technique, the current study analyzed 1379 published reviews (including star ratings) of 30 different VR relaxation applications available for the Oculus Go and Gear VR. The uncovered topic structure and sentiment analysis thereof suggests that users have an overall positive view of VR relaxation applications, describing them as successful in inducing immersion and relaxation, and having appreciated gamification elements. However, perceived quality varied substantially between applications that explained more variance in star ratings than specific features. Critical issues raised were both technical (e.g. "overheating") in nature and related to specific design elements and use. Implications for the design of consumer VR applications and future research are discussed.

Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial.

Public speaking anxiety (PSA) is a common condition which can be treated effectively with exposure therapy. However, inherent difficulties in stimuli presentation and control limits dissemination and the therapeutic potential. Virtual Reality (VR) technology has the potential to resolve these issues and provide a scalable platform for self-help interventions. No previous study has examined whether this can be achieved using the first generation of consumer VR hardware and software. In the current trial, n = 25 + 25 participants were randomized to either one-session therapist-led VR exposure therapy for PSA followed by a four-week internet-administered VR to in-vivo transition program, or a waiting-list. Linear mixed effects modeling revealed significant, large (within Cohen's d = 1.67) decreases in self-reported PSA. The waiting-list was then given access to an internet-administered, self-led version of the same VR exposure therapy to be conducted at home, followed by the same transition program. Dual-slope mixed effects modeling revealed significant, large (d = 1.35) decreases in self-reported PSA. Results were maintained or improved at six- and twelve-month follow-ups. We show for the first time that low-cost, off-the-shelf consumer VR hardware and software can be used to conduct exposure therapy for PSA, both in the traditional, previously impractical one-session format, and in a novel self-led, at-home format.