Process-based therapy

Question 1

What is the difference between mediation and moderation?

Answer 1

Mediation
- answer questions about why/how
- ex-> why do people experience less depression when undergoing behavioural activation
- about mechanisms of intervention
- third variable

Moderation
- answer questions about for whom and to what extend
- ex-> who benefits the most from behaivoural activation in term of depressive symptoms?
- individuals differences in response to intervention
- degree or size

Question 2

Why can focusing on reduction of psychological symptoms be problematic?

Answer 2

Usually treatment development focus on reduction of psychological symptoms which can be problematic because
- based on DSM which is criticize
- excessive co-occurence
- many risk and maintenance mechanisms are common to multiple psychological disorders→ avoidance, emotion regulation…

Question 3

What is process-based therapy?

Answer 3

Not outcome based therapy→ do not look at what therapy works better on average
- BUT look at process based therapy
- how does change comme about
- look at treatment explaining individuals differences
- what changes procedures are most effective
- what specific treatment works best
use the diemnsional model extended evolutionary meta-model (EEMM)

Question 4

How can research identify a mediator?

Answer 4

For mediation
- need to establish that mechanism is malleable
- mechanism relates strongly to both intervention and outcome
- Effect is specific and replicable across studies
- temporal precedence→ timeline is established, such that change in mechanism precedes change in outcome
—>BUT, statistically significant mediation does not = a mechanism

Question 5

How can research identify a moderator?

Answer 5

For moderation→
- Most often, demographic and other “moderators of convenience” are tested
- Can identify moderators based on knowledge of mechanisms, and moderator studies can further inform us about mechanism
—>moves from nomothetic to idiographic research methods

Question 6

How can research identify mediators and moderators?

Answer 6

How to do that
- functional analysis to look at maintaining contingencies
- used EMA to gather info for real life

Question 7

What is a difference between a change processe and a change procedure?

Answer 7

Change processes VS change procedure
- Cognitive defusion VS mindfulness
- Avoidance VS exposure
- Emotion regulation VS cognitive reappraisal

Question 8

How is process-based therapy usually structured?

Answer 8

• ask questions to gather individualized info
• use data to build model of how symptoms are maintained
• design treatment to stop loops
• change the treatment as we go

Question 9

What is personalizing psychotherapy?

Answer 9

Stumpp and Sauer-Zavala, 2021
- use patient’s preferences
- evidence based decisions for which part of treatment to focus on

Question 10

Which characteristics of the individual can we personalize psychotherapy for?

Answer 10

Personalize psychotherapy for
- Diagnosis
- Specific symptoms/psychological processes
- Personality traits
- Pre-existing psychological skills (capitalization→ enhancing strength vs. compensation→ targeting weaknesses)
- Response to treatment (and reasons for lack of response)
- Change in psychological mechanisms over time

Question 11

Which aspects of treatment can we personalize psychotherapy for?

Answer 11

Treatment selection
Inclusion of therapy skills
Order of therapy skills
- compensation, capitalization
Treatment changes
- Routine outcome monitoring
- SMARTs
Session frequency
Treatment termination
- brief VS full treatment

Question 12

What is some research evidence for personalizing psychotherapy?

Answer 12

Research evidence→ Sauer-Zavala, 2022
- SMART design to test personalization of unified protocol→
- examine effects of order of modules on rate of symptom improvement
- compared personalized selection of modules to full treatment
- 70 patients with emotional disorder
- randomized groups of standard, capitalization or compensation conditions
- after 6th session→ randomized to discontinue or full treatment
Results
- people liked the standard and capitalization a bit better than compensation
- prefer full treatment compared to discontinued treatment
- BUT no differences in symptoms reduction between the conditions

Question 13

What are the different modules of the unified protocol for emotional disorders?

Answer 13

Transdiagnostic treatment for people with emotional disorders
- could also be for ED, SUD or BPD

Modules
- Understanding emotions
- Increasing present-focused emotional awareness
- Increasing cognitive flexibility
- Identifying and preventing patterns of emotional avoidance and maladaptive emotion-driven behaviours
- Increasing awareness and tolerance of emotion-related physical sensations
- Interoceptive and situation-based emotion-focused exposure

Question 14

What is some research evidence for the unified protocol for emotional disorders?

Answer 14

Research evidence→ Farchione et al., 2012
- UP vs. wait-list control for patients with a principal anxiety disorder
- UP improved symptoms of anxiety and depression, levels of negative and
positive affect, and symptom interference in daily functioning
- Effects maintained over 6-month follow-up

Limitations
- No comparison to diagnosis-specific treatments
- Limited longitudinal follow-up data
- Limited data in other populations with problems with emotion regulation

Question 15

Explain the case of Amy using process-based therapy

Answer 15

Ong et al, 2023→ case of Emmy with GAD
- need to check things, indecision
- clarify values, more active,
- the distinct feature of PBT is that it also identifies the downstream and upstream variables tied to worry
- use a network modeling
- black arrow→ positive relation
- white arrow→ inhibitory effects
- create a self-amplifying loop
—>all of this maintain her GAD
- came from a personalized ecological momentary assessment
- use it to always update the network