Examining Change Mechanisms in Psychotherapy

Study Overview
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Brief Summary
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This research project seeks to acquire a deeper understanding of the complex influences of common factors and specific ingredients in psychotherapy. By using frequent process-outcome measures, it will address individualized mechanisms of change in psychotherapy by assessing both between and within patient change processes, using a wide spectrum of change indicators.

Detailed Description
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The study is a naturalistic study conducted by collecting data from in-patient units at Modum Bad (psychiatric hospital). The sample includes different patient groups with a variety of psychological disorders. Further, sample is gathered from units using different treatment approaches (short-term psychodynamic treatment, cognitive-behavioral treatment, metacognitive therapy, compassion-focused therapy, relational psychodynamic therapy, existential therapy and stabilizing trauma-therapy). The following specific research questions will be explored: The role of common factors: What are the relative influences of different common factors such as agreement on task and goals, treatment credibility and 'the real relationship', across treatments and diagnoses? Do some common factor variables stand out regarding ability to explain variance in outcome and across outcomes? Do measures of common factors have a consistent effect on outcome across treatment models and diagnoses, or does the explanatory value of common factors vary across diagnose and treatment model? The role of specific change mechanisms (affective, cognitive and meta-cognitive): To what extent do specific change mechanisms predict change in various outcome domains? Are these specific change mechanisms equally important predictors, or do they vary across treatment or diagnose? Are there interaction effects between common factors and specific factors across treatment models, patient diagnoses and outcome domain? Self-report data will be collected three times a week on mechanisms of change and symptoms, established by psychotherapy theory and research evidence as important for psychological change. The data collection consists of three different forms administered once per week on different days. The forms are separated by topic; symptoms, contextual factors, and change processes. The questions in the forms are selected from short instruments with good psychometric qualities. The data collection procedure has at present been tested on five patient cohorts with good results.

Official Title
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Examining Change Mechanisms in Psychotherapy: Relationship Between Specific Ingredients and Common Factors in Promoting Change.

Conditions
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Psychological Disorder, Anxiety Disorders, Depression, Eating Disorder, Post Traumatic Stress Disorder

Intervention / Treatment
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* Other: Psychotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Must be a patient at Modum Bad Have a psychological disorder Must have rights to treatment according to the rules of specialist health care in Norway. Includes the following: Patient is expected to have poorer prognosis of life quality if not given treatment It is expected that the patient will benefit from treatment It is expected that there is a reasonable cost-effect balance regarding the treatment given and the patient's benefit from treatment. Exclusion Criteria: Acute suicidality Ongoing/active abuse of harmful drug(s) Under 18 years

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Anxiety unit<br>Patients have anxiety as a primary diagnose. Receive treatment for anxiety (CBT and MCT). | Other: Psychotherapy<br>* There are different psychotherapy models offered across the units. All patients receive individual treatment and group therapy or psychoeducative groups.<br>|
| Eating disorder unit<br>Patients have eating disorder as primary diagnose. Receive treatment for their eating disorder (CBT and compassion-focused therapy). | Other: Psychotherapy<br>* There are different psychotherapy models offered across the units. All patients receive individual treatment and group therapy or psychoeducative groups.<br>|
| Depression unit<br>Patients have depression as primary disorder. Receive treatment for their depression (Short-term dynamic therapy, existential therapy and relational psychodynamic therapy). | Other: Psychotherapy<br>* There are different psychotherapy models offered across the units. All patients receive individual treatment and group therapy or psychoeducative groups.<br>|
| Family unit<br>One of the members of the family has a psychological disorder. The treatment is focused towards the family and family dynamics. | Other: Psychotherapy<br>* There are different psychotherapy models offered across the units. All patients receive individual treatment and group therapy or psychoeducative groups.<br>|
| Trauma unit<br>Patients have PTSD and relational trauma as primary diagnosis. Receive stabilizing treatment and exposure therapy. | Other: Psychotherapy<br>* There are different psychotherapy models offered across the units. All patients receive individual treatment and group therapy or psychoeducative groups.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Symptom checklist revised (SCL-90-R) | A general measure of symptoms distress | Change measure (baseline, 14 weeks, and 12 months). | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Inventory of interpersonal problems | Self-report questionnaire of interpersonal problems | Change measure (baseline, 14 weeks, and 12 months). | 
| Beck's depression inventory | Measure of depressive symptoms | Change measure (baseline, 14 weeks, and 12 months). | 
| PTSD checklist for Diagnostic and Statistical Manual 5 (PCL-5) | PTSD symptom measure | Change measure (baseline, 14 weeks, and 12 months). | 
| M-POQ outcome, anxiety | Measures anxiety symptoms | Change measure (baseline, 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks, 13 weeks and 14 weeks). | 
| M-POQ outcome, depression | Measures depression symptoms | Change measure (baseline, 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks, 13 weeks and 14 weeks). | 
| M-POQ outcome, loneliness | Measures experienced loneliness | Change measure (baseline, 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks, 13 weeks and 14 weeks). | 
| M-POQ outcome, resilience | Measures experienced recilience | Change measure (baseline, 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks, 13 weeks and 14 weeks). | 
| M-POQ outcome, well-being | Measures experienced well-being | Change measure (baseline, 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks, 13 weeks and 14 weeks). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Process-outcome study, Mechanisms of change