The adherence/resource priming paradigm – a randomised clinical trial conducting a bonafide psychotherapy protocol for generalised anxiety disorder

BMC Psychiatry

Christoph Flückiger¹ 

[1] Department of Psychology, University of Zürich, Binzmühlestr. 14/18, CH-8050 Zürich, Switzerland

关键词: Adherence;    Cognitive behaviour therapy;    Generalised anxiety disorder;   

Others  :  1123762
DOI  :  10.1186/1471-244X-14-49

 received in 2014-01-23, accepted in 2014-02-14,  发布年份 2014

【 摘 要 】

Background

Bonafide psychotherapy is an effective treatment for generalised anxiety disorder compared to no-treatment. Rather than creating increasing numbers of new overall treatment-packets within a medical meta-model, an additional approach to investigating clinical research designs may be to increase the understanding of already effective psychotherapies. Treatment manuals and protocols allow a relatively high degree of freedom for the way therapists implement the overall treatment manuals. There is a systematic lack of knowledge on how therapists should customise these overall protocols. The present study experimentally examines three ways of conducting a bonafide psychotherapy based on a 15 session time-limited cognitive-behavioural therapy (CBT) protocol and their relation to the therapists’ protocol adherence and treatment efficacy.

Methods/design

This trial will investigate three different methods of customising a bonafide CBT-protocol using dyadic peer-tutoring methodology (primings). The individuals with GAD will be randomly assigned to one of three priming conditions (resource priming, supportive resource priming, or adherence priming). The participant treatment allocation will be performed randomly. Therapists will be assigned to a peer-tutoring partner and priming condition based on a mutual agreement. Treatment outcomes will be assessed at the following times: observer based in-session outcomes, session-by-session post-session outcomes, treatment outcome at post assessment and treatment outcome at 6-month follow-up.

Discussion

The proposed trial addresses the clinically relevant question of how to customise a bonafide psychotherapy protocol using tandem peer-tutoring methodology (three priming conditions). Through the development and testing of the proposed priming procedures, this study describes levels of adherence and how to conduct an overall treatment protocol in a more systematised way.

Trial registration

From ClinicalTrials.gov Identifier: NCT02039193.

【 授权许可】

   
2014 Flückiger; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Angst J: Modern epidemiology of anxiety: results of the Zurich cohort study. Hum Psychopharm Clin 1999, 14:S29-S37.
• [2]Angst J, Gamma A, Baldwin DS, Ajdacic-Gross V, Rössler W: The generalized anxiety spectrum: prevalence, onset, course and outcome. Eur Arch Psy Clin N 2009, 259(1):37-45.
• [3]Hoyer J, Beesdo K, Becker ES, Wittchen H-U: Epidemiologie und nosologischer Status der Generalisierten Angststörung. Z Klin Psychol Psychother 2003, 32(4):267-275.
• [4]Lieb R, Becker E, Altamura C: The epidemiology of generalized anxiety disorder in Europe. Eur Neuropsychopharmacol 2005, 15(4):445-452.
• [5]Wittchen H-U, Zhao S, Kessler RC, Eaton WW: DSM-III—R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994, 51(5):355-364.
• [6]Borkovec TD: The nature, functions, and origins of worry. In Worrying: Perspectives on theory, assessment, and treatment. Edited by Davey GCL, Tallis F. Oxford, England: Wiley; 1994:5-33.
• [7]Borkovec TD, Alcaine O, Behar ES: Avoidance theory of worry and generalized anxiety disorde. In Generalized anxiety disorder: Advances in research and practice. Edited by Heimberg R, Mennin D, Turk C. New York, NY: Guilford; 2004:77-108.
• [8]Newman MG, Llera SJ: A novel theory of experiential avoidance in generalized anxiety disorder: a review and synthesis of research supporting a contrast avoidance model of worry. Clin Psychol Rev 2011, 31(3):371-382.
• [9]Roemer L, Salters K, Raffa S, Orsillo S: Fear and avoidance of internal experiences in GAD: preliminary tests of a conceptual model. Cogn Ther Res 2005, 29(1):71-88.
• [10]Mennin DS, Heimberg RG, Turk CL, Fresco DM: Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clin Psychol Sci Pract 2002, 9(1):85-90.
• [11]Mennin DS, McLaughlin KA, Flanagan TJ: Emotion regulation deficits in generalized anxiety disorder, social anxiety disorder, and their co-occurrence. J Anxiety Disord 2009, 23(7):866-871.
• [12]Turk CL, Heimberg RG, Luterek JA, Mennin DS, Fresco DM: Emotion dysregulation in generalized anxiety disorder: a comparison with social anxiety disorder. Cogn Ther Res 2005, 29(1):89-106.
• [13]Michelson SE, Lee JK, Orsillo SM, Roemer L: The role of values-consistent behavior in generalized anxiety disorder. Depress Anxiety 2011, 28(5):358-366.
• [14]Roemer L, Orsillo SM: Expanding Our conceptualization of and treatment for generalized anxiety disorder: integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clin Psychol Sci Pract 2002, 9(1):54-68.
• [15]Maack DJ, Tull MT, Gratz JL: Examining the incremental contribution of behavioral inhibition to generalized anxiety disorder relative to other Axis I disorders and cognitive-emotional vulnerabilities. J Anxiety Disord 2012, 26:689-695.
• [16]Cuijers P, Sijbradij M, Koole S, Huibers M, Berking M, Andersson G: Psychological treatment of generalized anxiety disorder: A meta analysis. Clin Psychol Rev 2014, 34(2):130-140.
• [17]Mitte K: Meta-analysis of cognitive-behavioral treatments for generalized anxiety disorder: a comparison with pharmacotherapy. Psychol Bull 2005, 131(5):785-795.
• [18]Hanrahan F, Field AP, Jones GW, Davey GCL: A meta-analysis of cognitive therapy for worry in generalized anxiety disorder. Clin Psychol Rev 2013, 33:120-132.
• [19]Wampold BE, Budge SL, Laska KM, Del Re AC, Baardseth TP, Flückiger C, Minami T, Kivlighan DMI, Gunn W: Evidence-based treatments for depression and anxiety versus treatment-as-usual: a meta-analysis of direct comparisons. Clin Psychol Rev 2011, 31:1304-1312.
• [20]Barlow DH, Rapee RM, Brown TA: Behavioral treatment of generalized anxiety disorder. Behav Ther 1992, 23(4):551-570.
• [21]Beck AT, Emery G, Greenberg RL: Anxiety disorders and phobias a cognitive perspective. New York: Basic Books; 1985.
• [22]Borkovec TD, Costello E: Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol 1993, 61(4):611-619.
• [23]Wells A: A metacognitive model and therapy for generalized anxiety disorder. Clin Psychol Psychother 1999, 6(2):86-95.
• [24]Zinbarg RE, Craske MG, Barlow DH: Mastery of Your Anxiety and Worry (MAW): Therapist Guide: Therapist Guide. New York: Oxford University Press; 2006.
• [25]Roemer L, Orsillo SM, Salters-Pedneault K: Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: evaluation in a randomized controlled trial. J Consult Clin Psychol 2008, 76(6):1083-1089.
• [26]Westra HA, Arkowitz H, Dozois DJA: Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: a preliminary randomized controlled trial. J Anxiety Disord 2009, 23(8):1106-1117.
• [27]Fava GA, Ruini C, Rafanelli C, Finos L, Salmaso L, Mangelli L, Sirigatti S: Well-being therapy of generalized anxiety disorder. Psychother Psychosom 2005, 74(1):26-30.
• [28]Knekt P, Lindfors O, Härkänen T, Välikoski M, Virtala E, Laaksonen MA, Marttunen M, Kaipainen M, Renlund C: Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychol Med 2008, 38(05):689-703.
• [29]Rashid T: Positive interventions in clinical practice. J Clin Psychol 2009, 65(5):461-466.
• [30]Padesky CA, Mooney KA: Strengths-based cognitive-behavioural therapy: a four-step model to build resilience. Clin Psychol Psychother 2012, 19(4):283-290.
• [31]Cheavens JS, Strunk DR, Lazarus SA, Goldstein LA: The compensation and capitalization models: a test of two approaches to individualizing the treatment of depression. Behav Res and Therapy 2012, 50(11):699-706.
• [32]Flückiger C, Grosse Holtforth M: Focusing the therapist’s attention on the patient’s strengths: a preliminary study to foster a mechanism of change in outpatient psychotherapy. J Clin Psychol 2008, 64(7):876-890.
• [33]Willutzki U, Neumann B, Haas H, Koban C, Schulte D: Zur Psychotherapie sozialer Ängste: Kognitive Verhaltenstherapie im Vergleich zu einem kombiniert ressourcenorientierten Vorgehen. Z Klin Psychol Psychother 2004, 33(1):42-50.
• [34]Teismann T, Dymel W, Schulte D, Willutzki U: Ressourcenorientierte akutbehandlung unipolarer depressionen. Eine randomisierte kontrollierte psychotherapiestudie. Psychother Psychosom Med Psychol 2011, 2011(61):295-302.
• [35]Snyder CR, Taylor JD: Hope as a common factor across psychotherapy approaches: a lesson from the “Dodo’s Verdict.”. In Handbook of hope: Theory, measures, and applications. 1st edition. Edited by Snyder CR. San Diego, CA: Academic Press; 2000:89-108.
• [36]Wampold BE, Budge SL: The 2011 leona tyler award address: the relationship—and its relationship to the common and specific factors of psychotherapy. Couns Psychol 2012, 40:601-623.
• [37]Bohart AC, Tallman K: How clients make therapy work the process of active self-healing. Washington, DC: American Psychological Association; 1999.
• [38]Bugas J, Silberschatz G: How patients coach their therapists in psychotherapy. Psychotherapy 2000, 37(1):64-70.
• [39]Flückiger C, Wüsten G, Zinbarg RE, Wampold BE: Resource activation - Using Clients’ Own Strengths in Psychotherapy and Counseling. Cambridge, MA: Hogrefe; 2010.
• [40]Gassmann D, Grawe K: General change mechanisms: the relation between problem activation and resource activation in successful and unsuccessful therapeutic interactions. Clin Psychol Psychother 2006, 13(1):1-11.
• [41]Smith E, Grawe K: What makes psychotherapy sessions productive? a new approach to bridging the gap between process research and practice. Clin Psychol Psychother 2003, 10(5):275-285.
• [42]Smith E, Grawe K: Which therapeutic mechanisms work when? A step towards the formulation of empirically validated guidelines for therapists’ session-to-session decisions. Clin Psychol Psychother 2005, 12(2):112-123.
• [43]Flückiger C, Caspar F, Grosse Holtforth M, Willutzki U: Working with patients’ strengths: a microprocess approach. Psychother Res 2009, 19(2):213-223.
• [44]Flückiger C, Zinbarg RE, Znoj H, Ackert M: Resource activation in generalized anxiety—an observer-based microprocess analysis of Patients’ in-session outcomes. Psychotherapy 2013. 10.1037/a0034119
• [45]Wampold BE: The Great Psychotherapy Debate: Models, Methods, and Findings. Taylor & Francis Group: New York, NY; 2001.
• [46]Stiles WB: Responsiveness as an obstacle for psychotherapy outcome research: It’s worse than You think. Clin Psychol Sci Pract 2009, 16(1):86-91.
• [47]Norcross JC: Psychotherapy Relationships That Work: Evidence-Based Responsiveness. 2nd edition. New York, NY: Oxford University Press; 2011.
• [48]Grawe K: Research-informed psychotherapy. Psychother Res 1997, 7(1):1-19.
• [49]Wampold BE: Psychotherapy: the humanistic (and effective) treatment. Am Psychol 2007, 62(8):857-873.
• [50]American Psychological Association - APA: Recognition of psychotherapy effectiveness. Psychotherapy 2013, 50:102-109.
• [51]Lambert MJ: Introduction and Historical Overview. In Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change. 6th edition. Edited by Lambert MJ. Hoboken, NJ: Wiley; 2013.
• [52]Webb CA, DeRubeis RJ, Barber JP: Therapist adherence/competence and treatment outcome: a meta-analytic review. J Consult Clin Psychol 2010, 78:200-211.
• [53]Eells TD, Lombart KG, Kendjelic EM, Turner LC, Lucas CP: The quality of psychotherapy case formulations: a comparison of expert, experienced, and novice cognitive-behavioral and psychodynamic therapists. J Consult Clin Psychol 2005, 73:579-589.
• [54]Zinbarg RE, Eun Lee J, Lira Yoon K: Dyadic predictors of outcome in a cognitive-behavioral program for patients with generalized anxiety disorder in committed relationships: a “spoonful of sugar” and a dose of non-hostile criticism may help. Behav Res Ther 2007, 45(4):699-713.
• [55]Flückiger C, Grosse Holtforth M: Ressourcenorientierte Mikroprozess Analyse (ROMA) - Ressourcendiagnostik und Ressourcenaktivierung im Therapieprozess. Zeitschrift für Klinische Diagnostik und Evaluation 2008, 1(2):171-185.
• [56]Flückiger C, Grosse Holtforth M, Znoj HJ, Caspar F, Wampold BE: Is the relation between early post-session reports and treatment outcome an epiphenomenon of intake distress and early response? A multi-predictor analysis in outpatient psychotherapy. Psychother Res 2013, 23:1-13.
• [57]Grawe K: Neuropsychotherapy : how the neurosciences inform effective psychotherapy. Mahwah, NJ: Lawrence Erlbaum; 2006.
• [58]Margraf J, Schneider S, Ehlers A: Diagnostisches Interview bei Psychischen Störungen (DIPS). Berlin, Germany: Springer; 1991.
• [59]Meyer TJ, Miller ML, Metzger RL DBT: Development and validation of the penn state worry questionnaire. Behaviours Research and Therapy 1990, 28:487-495.
• [60]Stöber J: Besorgnis: Ein Vergleich dreier Inventare zur Erfassung allgemeiner Sorgen. Zeitschrift für Differentielle und Diagnostische Psychologie 1995, 16:50-63.
• [61]Tallis F, Eysenck MW, Mathews A: WDQ. Questionnaire for the measurement of non-pathological worry. Personality and Individividual Differences 1992, 23:161-168.
• [62]Wittchen H-U, Zaudig M, Fydrich T: SKID. Strukturiertes Klinisches Interview für DSM-IV Achse I und II Handanweisung. Göttingen, Germany: Hogrefe; 1997.
• [63]Beck AT, Epstein N, Brown G, Steer RA: An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988, 56:893-897.
• [64]Margraf J, Ehlers A: BAI. Beck-Angstinventar. Hartcourt: Frankfurt, Germany; 2007.
• [65]Spielberger CD, Gorssuch RL, Lushene PR, Vagg PR, Jacobs GA: Manual for the State-Trait Anxiety Inventory (STAI). Palo Alto, CA: Consulting Psychologist Press; 1983.
• [66]Laux L, Glanzmann P, Schaffner P, Spielberger CD: State-Trait-Angstinventar (STAI). Beltz: Weinheim, Germany; 1981.
• [67]Beck AT, Steer RA KBG: BDI-II, Beck Depression Inventory. Boston: Harcourt, MA; 1996.
• [68]Hautzinger M, Keller F, Kühner C: BDI-II. Beck-Depressions-Inventor Revision. Pearson Assessment: Frankfurt, Germany; 2009.
• [69]Derogatis LR: BSI Brief Symptom Inventory: Administration, Scoring, and Procedure Manual. Minneapolis, NN: National Computer Systems; 1993.
• [70]Franke GH: Brief Symptom Inventory von L. R. Derogatis (Kurzform der SCL-90-R) -Deutsche Version. Beltz: Weinheim, Germany; 2000.
• [71]Carver CS, White TL: Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: The BIS/BAS scales. J Pers Soc Psychol 1994, 67:319-333.
• [72]Strobel A, Beauducel A, Debener S, Brocke B: Eine deutschsprachige Version des BIS/BAS-Fragebogens von Carver und White. Zeitschrift für Differentielle und diagnostische Psychologie 2001, 22:216-227.
• [73]Horowitz LM, Rosenberg SE, Baer BA, Ureño G, Villaseñor VS: Inventory of interpersonal problems: psychometric properties and clinical applications. J Consult Clin Psychol 1988, 56:885-892.
• [74]Horowitz LM, Strauß B, Kordy H: Das Inventar zur Erfassung interpersonaler Probleme (IIP-64-D) [Inventory of interpersonal problems, German version]. Beltz: Weinheim, Germany; 2000.
• [75]Hatcher RL, Rogers DT: Development and validation of a measure of interpersonal strengths: the inventory of interpersonal strengths. Psychol Assess 2009, 21:554-569.
• [76]Flückiger C, Caspar F, Grosse Holtforth M: Inventar Interpersoneller Stärken von Hatcher & Rogers (IIS-64-D). Bern: University of Bern; 2011.
• [77]Troesken A, Grawe K: Ressourcenpotential und -realisierung für Psychologische Therapie. Verhaltenstherapie & Psychosoziale Praxis 2004, 36:51-62.
• [78]Hatcher RL, Gillaspy JA: Development and validation of a revised short version of the working alliance inventory. Psychother Res 2006, 16:12-25.
• [79]Munder T, Wilmers F, Leonhart R, Linster HW, Barth J: Working alliace inventory-shrt revised (WAI-SR). Psychometric properties in outpatients and inpatients. Clin Psychol Psychother 2010, 17:231-239.
• [80]Flückiger C, Regli D, Zwahlen D, Hostettler S, Caspar F: Der Berner Therapeuten- und Patientenstundenbogen 2000. Ein Instrument zur Erfassung von Therapieprozessen. Z Klin Psychol Psychother 2010, 39:71-79.
• [81]Sachse R: Differential effects of processing proposals and content references on the explication process of clients with different starting conditions. Psychother Res 1992, 2(4):235-251.
• [82]Carver CS: Adult attachment and personality: Converging evidence and a new measure. Pers Soc Psychol Bull 1997, 23:865-883.
• [83]Hackelöer A, Löwe B, Spitzer C: Die deutsche Version des Measure of Attachment Qualities (MAQ-D): Erste Befunde zu den psychometrischen Gütekriterien. Psychother Psychosom Med Psychol 2009, 59(02): .
• [84]Sandell R, Carlsson J, Schubert J, Broberg J, Lazar A, Grant J: Therapist attitudes and patients’ outcomes. I. Development and validation of the Therapist Attitudes Scales (TASC2). Psychother Res 2004, 14:469-484.
• [85]Raudenbush SW, Bryk AS: Hierarchical linear models : applications and data analysis methods. 2nd edition. Thousand Oaks, CA: Sage Publications; 2002.
• [86]Faul F, Erdfelder E, Lang A-G, Buchner A: G*Power 3: A flexible statistical power analysis for the social, behavioral, and biomedical sciences. Behav Res Methods 2007, 39:175-191.
• [87]Baldwin SA, Imel ZE: Therapist effects: Findings and methods. In Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change. edn. Edited by Lambert MJ. Hoboken, NJ: Wiley; 2013.
• [88]Castonguay LG, Goldfried MR, Wiser S, Raue PJ, Hayes AM: Predicting outcome in cognitive therapy for depression: a comparison of unique and common factors. J Consult Clin Psychol 1996, 64:497-504.