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Introduction: Ample research has established that interpersonal isolation—the objective separateness from others—is a correlate of maladaptive psychological outcomes. However, existential isolation (EI)—the feeling of aloneness in one's subjective experience—has received less empirical attention. From the limited existing research, higher EI has been associated with greater severity of mental health concerns and more negative beliefs about treatment. Yet, these investigations have largely been conducted with non-clinical samples. Further, virtually no studies have examined EI as a predictor of current psychotherapy outcomes. Moreover, given their risk of holding negative treatment beliefs, it is plausible that therapy would be most effective if more existentially isolated individuals experienced being well matched to their therapist. This study extended EI research to a clinical sample and provided a novel test of EI as a direct predictor of outcome and moderator of a patient-therapist match system in naturalistic psychotherapy. Method: Data derived from a randomized trial comparing the effectiveness of prospectively matching patients (N = 218) to therapists (N = 48) with empirical strengths in treating the patient's specific presenting problem(s) versus case assignment as usual (Constantino et al., 2021). Patients rated EI at baseline and mental health outcomes repeatedly through treatment. We conducted correlations to examine baseline EI-symptom associations and multilevel modeling to test EI as a predictor of symptom change and moderator of the known beneficial match effect on outcome. Results: As predicted, higher EI was associated with greater depression, anxiety, and distress at baseline, as well as poorer therapy outcome across and at the end of treatment. In the expected direction, though not to a statistically significant level, the positive match effect was stronger for patients with higher versus lower EI. Discussion: We discuss research and practice implications at the intersection of social and clinical psychology.

OBJECTIVE: Given its interpersonal underpinnings, relational factors may be salient in psychotherapy for generalized anxiety disorder (GAD). Supporting this point, research has indicated a positive total alliance-improvement correlation in cognitive behavioral therapy (CBT) for GAD. However, less research has disaggregated this correlation into within- and between-patient components, or examined theory-informed ways in which patient characteristics influence to these components. Thus, we first investigated parsed alliance-outcome associations in CBT for GAD. Second, consistent with theory that alliance may represent a direct interpersonal change correlate, we tested whether within-patient alliance improvements were especially therapeutic for patients with higher levels of an interpersonal problem prototypical of GAD—over accommodation. Also, consistent with theory that between-patient differences in overall alliance may be influenced by patients’ preexisting relational characteristics, we tested whether more overly accommodating patients reported poorer average alliances that, in turn, related to worse outcomes. METHOD: Sixty-nine patients received variants of CBT. Patients rated over accommodation at baseline, and alliance and outcome across treatment. RESULTS: As hypothesized, within-patient alliance improvements correlated with subsequent anxiety reduction, and this association was stronger for more overly accommodating patients. All between-patient associations were nonsignificant. CONCLUSION: Results help clarify the nuanced role of alliance in CBT for GAD.

OBJECTIVE A double-blind, randomized controlled trial tested the effectiveness of a personalized Match System in which patients are assigned to therapists with a "track record" of effectively treating a given patient's primary concern(s) (e.g., anxiety). Matched patients demonstrated significantly better outcomes than those assigned through usual pragmatic means. The present study examined patient-level moderators of this match effect. We hypothesized that the match benefits would be especially pronounced for patients who presented with (a) greater overall problem severity, and (b) greater problem complexity (i.e., number of elevated problem domains). We also explored if patient racial/ethnic minority status moderated the condition effect. METHOD Patients were 218 adults randomized to the Match or as-usual assignment condition, and then treated naturalistically by 48 therapists. The primary outcome was the Treatment Outcome Package (TOP), a multidimensional assessment tool that also primed the Match algorithm (based on historical, therapist-level effectiveness data), and assessed trial patients' symptoms/functioning and demographic information at baseline. Moderator effects were tested as patient-level interactions in three-level hierarchical linear models. RESULTS The beneficial match effect was significantly more pronounced for patients with higher initial severity (-0.03, 95% CI -0.05, -0.01) and problem complexity (-0.01, 95% CI -0.02, -0.004), yet the high correlation between severity and complexity called into question the uniqueness of the complexity moderator effect. Moreover, the match effect was more pronounced for racial/ethnic minority patients (i.e., nonwhite; -0.05, 95% CI -0.09, -0.01). CONCLUSIONS Measurement-based matching is especially effective for patients with certain characteristics, which further informs mental health treatment personalization. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVE Although higher quality patient-therapist alliance and more positive patient outcome expectation (OE) consistently predict symptomatic/functional improvement in psychotherapy, most research has failed to capture the nuance in these process-outcome relations by parsing them into within-therapist (i.e., differences between patients treated by the same therapist) and between-therapist (i.e., differences between therapists' average process/outcome ratings across all patients in their caseloads) components. Moreover, the few studies that have done so have produced mixed results, suggesting the possibility of systematic variability in these associations (i.e., moderators). One potential source of such variability could be providers themselves; that is, different therapists could use these processes to differing therapeutic benefit. This study tested the alliance- and OE-outcome associations at both the within- and between-therapist levels and explored therapist-level moderators of them. METHOD Data derived from 212 adult outpatients treated naturalistically by 42 psychotherapists as part of a randomized trial that compared different case-assignment methods. Patients completed measures of alliance, OE, and outcome repeatedly throughout treatment. Therapist characteristics were assessed at baseline. RESULTS Multilevel structural equation models revealed that, at the between-therapist level, only higher alliance quality, but not more optimistic OE, was associated with greater caseload-level improvement. At the within-therapist level, only more optimistic OE, but not higher alliance quality, was associated with patient improvement. Finally, therapists' self-perceived alliance-fostering effectiveness and cognitive-behavioral orientation moderated the within- and between-therapist alliance-outcome associations, respectively. CONCLUSION Results indicate that different therapists use common treatment processes to differing therapeutic benefit, which can inform more personalized clinical practices and trainings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Given the many evidence-supported psychotherapy interventions, and the fact that no single approach or therapist can successfully help all patients, in recent years, there has been a surge in studies focused on evidence-based methods of tailoring treatment to patients, providers, and processes. Although the field still has a long way to go in reliably mapping specific empirically supported avenues to personalized therapies, emerging results from this line of research underscore the potential for such optimization. In this vein, the articles in the special issue describe some of the most auspicious recent developments in the field of personalized mental health treatment. In this introduction to the special issue, we synthesize the articles and propose a list of some of the most promising personalization principles. These include (a) a diversity of aims that the approaches seek to achieve; (b) a diversity of outcomes used to evaluate the merits of these approaches; (c) the information on which the tailoring is based; (d) the tailoring approaches themselves; and (e) the research designs used to evaluate them. These pathways can inform the most current tailoring guidelines that can help clinical decision-making and inspire future translational science in this area. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective Although therapist supportive, rather than directive, strategies have been particularly indicated during client resistance, little systematic research has examined how therapists responsively navigate resistance in different therapy approaches and how this responsiveness is related to outcome. Method In the context of disagreement episodes in cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD; Westra, H. A., Constantino, M. J., & Antony, M. M. Integrating motivational interviewing with cognitive-behavioral therapy for severe generalized anxiety disorder: An allegiance-controlled randomized clinical trial. Journal of Consulting and Clinical Psychology, 84(9), 768-782. https://doi.org/10.1037/ccp0000098, 2016), the present study examined (1) the degree to which therapist management of resistance differed between therapists trained in CBT integrated with motivational interviewing (MI-CBT; i.e., training centered on the responsive management of resistance) and therapists trained in CBT-alone, and (2) the impact of specific therapist behaviors during disagreement on client worry outcomes immediately posttreatment and 1-year posttreatment. Episodes of disagreement were rated used the Structural Analysis of Social Behavior (Benjamin, L. S. Structural analysis of social behavior. Psychological Review, 81(5), 392-425. https://doi.org/10.1037/h0037024, 1974). Results Therapists trained in MI-CBT were found to exhibit significantly more affiliative and fewer hostile behaviors during disagreement compared to those trained in CBT-alone; both of these, in turn, were found to mediate client 1-year posttreatment outcomes, such that increased affiliation during disagreement was associated with improved outcomes. Conclusion This study highlights the value of training therapists in the responsive detection and management of resistance, as well as the systematic integration of MI into CBT.

Although evidence-based psychotherapies, such as cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT), produce comparable average outcomes, it is plausible that some patients who possess one or more specific characteristics may respond better to one over the other. Addressing this

Positive patient-rated psychotherapy outcome expectation at pre- or early treatment is associated with posttreatment improvement. However, there is limited research on patients' change in outcome expectation across therapy and participant factors that predict both pretreatment outcome expectation and expectation change. The present study aimed to examine (a) the overall trajectory of change in patients' outcome expectation from pretreatment through treatment's end; (b) baseline patient characteristics as predictors of their pretreatment outcome expectation; (c) early change in general self-efficacy (controlling for baseline patient characteristics, early change in symptoms, and treatment condition) as predictor of expectation change; and (d) therapist effects on patients' outcome expectation change. For patients with generalized anxiety disorder (N = 80) receiving variants of cognitive-behavioral therapy, outcome expectation was assessed at pretreatment, Session 5, Session 10, and posttreatment. Using multilevel models with repeated assessments, we found outcome expectation to linearly increase from pre- to posttreatment. When controlling for other patient characteristics at intake, higher depression severity was associated with lower pretreatment outcome expectation. When controlling for baseline patient characteristics, early reduction in generalized anxiety disorder-symptoms and global severity, and treatment condition, an increase in early general self-efficacy was associated with a less steep increase in outcome expectation over the therapy. We also found between-therapist differences in their patients' average outcome expectation change. Results shed additional light on various participant characteristics that influence patients' pretreatment outcome expectation and expectation change through therapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Deliberate practice (DP) is an emerging training method for improving individual performance that may be worth adapting and testing for applicability to groups, given the prevalence of group training for continuing education. This study compared an adapted DP workshop to the same traditional, non-DP workshop for managing ambivalence and resistance. The same presenter delivered the workshops to 88 randomly assigned community psychotherapists. The DP workshop involved repeated interaction with multiple recreations of resistance, with consistent group feedback especially on ideal expert performance. The control workshop was more didactic, with fewer opportunities for practice and feedback. We assessed video vignette performance and coded 20-min interviews with ambivalent interviewees from the community. Both workshops produced equivalent trainee satisfaction and significant increases in self-reported skills. However, the DP versus control group demonstrated better observer-rated skill on all performance measures postworkshop. Although skills declined to 4-month retest in both groups, the DP trainees retained their relative advantage over traditional workshop trainees. Moreover, at the 4-month follow-up, DP versus control trainees were rated as more empathic by community interviewees and self-reported practicing the skills at higher rates. These findings support the continued investigation of DP as a means for improving therapist skill in continuing education workshops. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The quiet ego-a personality construct characterized by empathy, inclusivity, non-defensiveness, and growth-mindedness in self-other relations-correlates positively with varied health markers. There is also emerging evidence that quiet-ego-based interventions may have a positive impact on health-related outcomes. However, no research has examined whether such interventions promote psychologicalThe online version contains supplementary material available at 10.1007/s10902-022-00560-z.

Performance accountability-also frequently referred to as quality improvement in the fields of medicine and public policy-is under growing scrutiny in mental and behavioral health care. As one high-profile example, psychologists and other mental health providers will be deemed "eligible clinicians" under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act starting in 2019. This will incentivize psychologists to track their Medicare patients' clinical outcomes and report them in data registries, and those who do not will suffer a reimbursement penalty. However, many psychologists are not aware of these developments or prepared for this change. The goal of this article is to provide information to psychologists about quality improvement and clinical data registries from four distinct, though overlapping, vantage points: professional governance, quantitative research, qualitative research, and clinical practice. We review recent regulations and research in this area, with an emphasis on exploring both the potential benefits and challenges of quality improvement. We conclude by providing recommendations for the field of psychology. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Research on close relationships demonstrates that dyadic convergence, or two people becoming more similar in their experiences and/or beliefs over time, is commonplace and adaptive. As psychotherapy involves a close relationship, patient-therapist convergence processes may influence treatment-specific outcomes. Although prior research supports that patients and therapists tend to converge on their alliance perspectives over time, which associates with subsequent patient improvement, no research has similarly examined

Although a historically prominent model of evidence-based practice (EBP) privileges the faithful delivery of single empirically supported treatment (EST) packages, psychotherapy research demonstrates that therapist adherence to an EST is often unrelated to patient outcome. Additionally, perseverative adherence when facing disruptive clinical process can relate to worse outcomes. In contrast, unmanipulated within-case variability in adherence, or the natural incorporation of theoretically “off-brand” interventions into an EST, can associate with more improvement. Further supporting the value of therapist flexibility, treatments that intentionally integrate theory-informed departures (away from the foundational EST) vis-a-vis specific disruptive clinical processes can outperform the standard EST without such departures. Thus, responsively adjusting treatments, such as cognitive-behavioral therapy (CBT), to patients’ contextualized pathology, characteristics, and momentary interactions with the provider may represent a more empirically well-supported form of EBP. Consistent with these ideas, we present an overview of context-responsive psychotherapy integration (CRPI), an approach to EBP in an if-then key. CRPI frames common factors as typical and potentially disruptive clinical “if” situations that therapists will encounter and to which they “then” need to be responsive beyond strict adherence to any EST. Notably, such departures can be temporary, thereby supporting vs. replacing the primary EST interventions. To illustrate CRPI’s application to practice, we focus on one example of patient resistance to CBT as a contextual process marker and motivational interviewing as a theory- and evidence-informed departure response. We also discuss clinical, cultural, empirical, and training considerations from the CRPI perspective.

Objective This study aimed to identify differential patient change processes and mechanisms associated with long-term outcome in exposure-based cognitive therapy (EBCT) and cognitive-behavioral therapy (CBT) for depression. Method We drew on a randomized controlled trial in which 149 patients were randomly assigned to either EBCT or CBT, with the treatments showing comparable efficacy at 12-month follow-up (grosse Holtforth et al., 2019). Based on Doss's (2004) 4-step model of psychotherapy change and using sequential multilevel structural equation models, we tested putative theory-based change processes and mechanisms for both treatments. Specifically, we examined emotional processing and cognitive restructuring during treatment as hypothesized change processes of EBCT and CBT, respectively. Furthermore, as potential change mechanisms during follow-up, we examined theory-relevant mechanisms for each treatment, preselected via multilevel models. Results Although the full serial mediational pathways were not supported, EBCT fostered greater during-treatment increases in emotional processing and higher self-efficacy during follow-up than CBT, both of which associated with better long-term depression outcome. Unexpectedly, cognitive restructuring change did not differ between EBCT and CBT. Across both CBT and EBCT, greater during-treatment increases in cognitive restructuring related to lower cognitive-behavioral avoidance and greater self-efficacy across follow-up, which associated with lower long-term depression. Conclusions Results suggest that therapists might improve long-term depression outcome by fostering both emotional processing (via emotion-focused techniques as included in EBCT) and cognitive restructuring (by using general CBT techniques included in both treatments), which operate either directly or through varied treatment-common mechanisms (e.g., greater self-efficacy and reduced cognitive-behavioral avoidance). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

In a randomized trial for generalized anxiety disorder, cognitive-behavioral therapy (CBT) and CBT integrated with motivational interviewing (MI) promoted comparable worry reduction at posttreatment, whereas MI-CBT outperformed CBT over 12-month follow-up (Westra, Constantino, & Antony, 2016). Secondary analyses revealed competing mediators of the long-term treatment effect: MI-CBT related to lower patient resistance to the treatment, which promoted lower follow-up worry, whereas CBT related to greater increases in patient friendly submissiveness (FS), or compliance, which also promoted lower follow-up worry (that suppressed an even greater long-term advantage of MI-CBT). In this study, we tested these competing, though theoretically consistent, variables as mediators of the nonsignificant treatment effect on posttreatment worry, as there could also be treatment-specific means to arriving to these comparable ends. Eighty-five patients received 15 sessions of MI-CBT or CBT. Therapists rated patient FS through treatment, observers rated resistance at midtreatment, and patients rated worry at posttreatment. Bootstrap analyses indicated that MI-CBT patients exhibited less resistance, which promoted lower posttreatment worry, whereas CBT patients had greater increases in FS, which also promoted lower worry. CBT and MI-CBT achieved comparable posttreatment outcomes through separate indirect paths that each conferred an advantage for one treatment over the other (and had canceled out a direct treatment effect immediately after therapy). The composite trial findings have significance for understanding different pathways to personal change in both the short- and long terms, and for the importance of testing indirect effects both when direct treatment effects do and do not emerge. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: A meta-analysis revealed a positive correlation between patients’ optimistic baseline, or early treatment, outcome expectation (OE) and posttreatment improvement (Constantino, Visla, et ...

Importance Psychotherapists possess strengths and weaknesses in treating different mental health problems, yet performance information is rarely harnessed in mental health care (MHC). To our knowledge, no prior studies have tested the causal efficacy of prospectively matching patients to therapists with empirically derived strengths in treating patients' specific concerns. Objective To test the effect of measurement-based matching vs case assignment as usual (CAU) on psychotherapy outcomes. Design, setting, and participants In this randomized clinical trial, adult outpatients were recruited between November 2017 and April 2019. Assessments occurred at baseline and repeatedly during treatment at 6 community MHC clinics in Cleveland, Ohio. To be eligible, patients had to make their own MHC decisions. Of 1329 individuals screened, 288 were randomized. Excluding those who withdrew or provided no assessments beyond baseline, 218 patients treated by 48 therapists were included in the primary modified intent-to-treat analyses. Interventions Therapist performance was assessed pretrial across 15 or more historical cases based on patients' pre-post reporting across 12 problem domains of the routinely administered Treatment Outcome Package (TOP). Therapists were classified in each domain as effective (on average, patients' symptoms reliably improved), neutral (on average, patients' symptoms neither reliably improved nor deteriorated), or ineffective (on average, patients' symptoms reliably deteriorated). Trial patients were randomly assigned to good-fitting therapists (matched group) or were assigned to therapists pragmatically (CAU group). There were multiple match levels, ranging from therapists being effective on the 3 most elevated domains reported by patients and not ineffective on any others (highest) to not effective on the most elevated domains reported by patients but also not ineffective on any domain (lowest). Therapists treated patients in the matched and CAU groups, and treatment was unmanipulated. Main outcomes and measures General symptomatic and functional impairment across all TOP domains (average z scores relative to the general population mean; higher scores indicate greater impairment), global distress (Symptom Checklist-10; higher scores indicate greater distress), and domain-specific impairment on each individual's most elevated TOP-assessed problem. Results Of 218 patients, 147 (67.4%) were female, and 193 (88.5%) were White. The mean (SD) age was 33.9 (11.2) years. Multilevel modeling indicated a match effect on reductions in weekly general symptomatic and functional impairment (γ110 = -0.03; 95% CI, -0.05 to -0.01; d = 0.75), global distress (γ110 = -0.16; 95% CI, -0.30 to -0.02; d = 0.50), and domain-specific impairment (γ110 = -0.01; 95% CI -0.01 to -0.006; d = 0.60), with no adverse events. Conclusions and relevance Matching patients with therapists based on therapists' performance strengths can improve MHC outcomes. Trial registration ClinicalTrials.gov Identifier: NCT02990000.

The emblem of success in psychotherapy research and practice has long been innovation. Although such ingenuity is commendable, it has nonetheless perpetuated fragmentation across the field. At least four decades ago, it was suggested that achieving consensus on what constitutes psychotherapy’s theoretical, empirical, and practical ‘core’ might allow the discipline to evolve beyond its siloed state, as is reflective of mature science. Yet, division remains the rule versus exception, owing in large part to power struggles among disparate schools of therapy and quarrels over whether theory-specific or theory-common factors most account for therapeutic change. We outline here a vision for psychotherapy’s future that is defined by consensus rather than disintegration. Namely, we reiterate the need for the field to invest in clinical strategies that transcend ostensibly incompatible theoretical models. We also argue that psychotherapy research should build on the growing evidence for such clinical strategies in an effort to establish core, evidence-based principles of therapeutic change. We then discuss how establishing consensus will require reconciliation among the mounting evidence for flexible, principle-informed practice with the current realities of training, dissemination, and implementation paradigms. Finally, we articulate ways in which practicing clinicians will serve a vital role in carrying out, and amending as needed, actionable efforts toward psychotherapy consensus.

Objective Although a better therapeutic alliance associates with treatment outcome, it may do so in different ways. For example, alliance quality may promote improvement as it shifts over time (within-patient changes); alternatively, alliance quality may also, or instead, influence outcome when generally higher or lower for some patients relative to others (between-patient differences). Although both components have been linked to patient improvement, the distinct mechanisms of these associations have been rarely examined. Conceptually, it follows that within-patient alliance fluctuations (representing the changing nature of a current relationship intended to be ameliorative) may facilitate other interpersonal improvements that could, in turn, translate into symptom reduction. This path squares with the corrective relational experience notion. In contrast, whereas as patients' average alliances across therapy may generally facilitate or hinder improvement, the mechanism may not be other relationship functioning. This squares with the notion that when people generally experience good alliances with their therapist, it may reflect an existing relational ability that catalyzes the effectiveness of other nonrelational therapeutic means. This study tested these distinct hypotheses. Method Patients (N = 85) with generalized anxiety disorder were randomly assigned to cognitive-behavioral therapy, either alone or integrated with motivational interviewing. They rated alliance quality, interpersonal problems, and outcome repeatedly. Results Using multilevel structural equation modeling, both within- and between-patient alliances related to subsequent worry reduction. As predicted, change in interpersonal problems mediated the association only at the within-patient level. Conclusions Results contribute to the literature on mechanisms of the within- and between-person alliance-outcome association. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited treatment supported by research spanning >4 decades. IPT focuses on stressful interpersonal experiences of loss, life changes, disputes, and social isolation. It emphasizes the role of relationships in recovery. This scoping review describes, within a historical perspective, IPT's evolution as an evidence-supported treatment of psychiatric disorders. Methods English-language publications (n = 1119) identified via EMBASE, MEDLINE, PsycINFO, and Web of Science databases (1974-2017), augmented with manual reference searches, were coded for clinical focus, population demographics, format, setting, publication type, and research type. Quantitative and qualitative analyses identified IPT publications' characteristics and trends over four epochs of psychotherapy research. Results IPT literature primarily focused on depression (n = 772 articles; 69%), eating disorders (n = 135; 12%), anxiety disorders (n = 68; 6%), and bipolar disorder (n = 44; 4%), with rising publication rates and numbers of well-conducted randomized, controlled trials over time, justifying inclusion in consensus treatment guidelines. Research trends shifted from efficacy trials to effectiveness studies and population-based dissemination initiatives. Process research examined correlates of improvement and efficacy moderators. Innovations included global initiatives, prevention trials, and digital, web-based training and treatment. Conclusion Sparked by clinical innovations and scientific advances, IPT has evolved as an effective treatment of psychiatric disorders across the lifespan for diverse patients, including underserved clinical populations. Future research to elucidate mechanisms of change, improve access, and adapt to changing frameworks of psychopathology and treatment planning is needed. IPT addresses the universal centrality of relationships to mental health, which is as relevant today as it was over 40 years ago.

Research demonstrates variability in mental health clinicians' overall and domain-specific outcomes for their patients. Despite calls to increase patient access to provider performance information, little is known about patients' attitudes toward and valuing of this information. This study explored patient attitudes, preferences, and values regarding the use of clinician outcome track records in provider selection and treatment decision making.Community mental health patients (N=403) completed a multicomponent survey, and a subset of patients (N=15) completed a follow-up semistructured interview. Interview data were analyzed with consensual qualitative methods.Overall, participants endorsed valuing access to clinician outcome track record information and endorsed the belief that using such information would enhance the referral process and promote better mental health outcomes.Harnessing measurement-based information on clinicians' effectiveness to make more personalized treatment decisions could promote better treatment engagement, retention, and outcomes.