Timothy Anderson

Quality of Object Relations and Security of Attachment as Predictors of Early Therapeutic Alliance.

Security of attachment and quality of object relations were measured as predictors of initial impressions of the therapeutic alliance as well as dropout. Fifty-five individual psychotherapy clients were administered the Revised Adult Attachment Scale and the Bell Object Relations and Reality Testing Inventory prior to their initial therapy session. Thirty of these participants completed the Working Alliance Inventory following their 1 st, 2nd, and 3rd sessions. Security of attachment and quality of object relations were strongly related. Security of attachment and quality of object relations showed relations to early alliance that decreased over time. Attachment and object relations were not related to dropout. Limitations include small sample size and low research compliance rate.

Emotional distress in nonmetropolitan persons living with HIV disease enrolled in a telephone-delivered, coping improvement group intervention

The study delineated depressive symptoms and modeled emotional distress in persons living with HIV disease in nonmetropolitan areas of 13 U.S. states. Participants (N=329) were enrolled in a randomized clinical trial of a telephone-delivered, coping improvement group intervention, and 60% reported moderate or severe levels of depressive symptomatology on the Beck Depression Inventory. Structural equation modeling indicated that participants who experienced more severe HIV symptomatology, received less social support, and engaged in more avoidant coping also experienced more emotional distress (a latent construct comprising depressive symptoms and emotional well-being). Greater HIV-related stigma and rejection by family led to more emotional distress, with social support and avoidant coping mediating almost entirely the effects of the former 2 variables. The model accounted for 72% of the variance in emotional distress in nonmetropolitan persons living with HIV disease.

Effects of day-to-day affect regulation on the pain experience of patients with rheumatoid arthritis

Abstract Individual differences in the regulation of affect are known to impact pain and other symptoms in rheumatoid arthritis. However, no studies have yet used a rigorous daily diary methodology to address the question of whether current pain is reduced when positive or negative affects are effectively regulated. We used a prospective, repeated daily sampling design to infer the regulation of affect from day‐to‐day changes in affect intensity and examined how these changes in affect were prospectively related to pain from rheumatoid arthritis. Ninety‐four adult patients diagnosed with rheumatoid arthritis completed daily measures of pain and positive and negative affect over a period of 30 days. Information on demographic and disease status variables was collected during a medical evaluation. Results of hierarchical linear model analyses indicated that the regulation of both positive and negative affect from the prior day to the current day predicted significantly greater decreases in pain that day, resulting in up to a 28% reduction in pain intensity. These findings were partly influenced by disease status and demographic variables. This study suggests that the day‐to‐day regulation of negative and positive affect is a key variable for understanding the pain experience of individuals with rheumatoid arthritis and is a potentially important target for intervention.

Telephone-Delivered, Interpersonal Psychotherapy for HIV-Infected Rural Persons With Depression: A Pilot Trial

OBJECTIVE Rural areas account for approximately 6% of AIDS cases in the United States. Many HIV-infected persons in rural areas live with elevated levels of psychiatric distress, suicidal ideation, and loneliness. This pilot study tested whether brief interpersonal psychotherapy delivered via telephone could reduce psychiatric distress among persons living with HIV-AIDS in rural areas in the United States. METHODS Seventy-nine participants were assigned randomly to a usual care control condition or to a six-session, telephone-delivered, interpersonal psychotherapy intervention (hereafter referred to as the teletherapy group); participants in the teletherapy group continued to receive standard services available to them in the community. Participants completed self-administered surveys pre- and postintervention that assessed depressive and psychiatric symptoms, perceptions of loneliness, and social support. RESULTS Participants in the teletherapy group evidenced greater reductions in depressive symptoms and in overall levels of psychiatric distress, compared with those in the control group. Nearly one-third of teletherapy participants reported clinically meaningful reductions in psychiatric distress from pre- to postintervention. CONCLUSIONS The telephone-delivered interpersonal therapy intervention showed potential to reduce depressive and psychiatric symptoms among HIV-infected persons in rural areas. On the basis of these encouraging findings, additional research examining this intervention with this clinical population is warranted.

Effects of a Brief Media Intervention on Expectations, Attitudes, and Intentions of Mental Health Help Seeking

This study examined the effects of a mass-media video intervention on expectations, attitudes, and intentions to seek help from professional mental health care services. A public service announcement-style, mass-media video intervention was developed, with prior empirical research on help-seeking behaviors organized according to the theory of reasoned action/planned behavior. In total, 228 participants were randomly assigned to 1 of 2 conditions: (a) the media-exposed intervention group, who watched programming in which the media intervention was inserted, and (b) the control group, who watched the same programming without the media intervention. The media intervention was not influential on expectation and belief-based barrier variables. However, the media intervention was effective at increasing positive attitudes toward help seeking. Findings regarding the interventions ability to increase help-seeking intentions for interpersonal problems were complex. Implications of these findings for future research are discussed.

A randomized, controlled trial of emotional disclosure in rheumatoid arthritis: Can clinician assistance enhance the effects?

&NA; Emotional disclosure by writing or talking about stressful life experiences improves health status in non‐clinical populations, but its success in clinical populations, particularly rheumatoid arthritis (RA), has been mixed. In this randomized, controlled trial, we attempted to increase the efficacy of emotional disclosure by having a trained clinician help patients emotionally disclose and process stressful experiences. We randomized 98 adults with RA to one of four conditions: (a) private verbal emotional disclosure; (b) clinician‐assisted verbal emotional disclosure; (c) arthritis information control (all of which engaged in four, 30‐min laboratory sessions); or (d) no‐treatment, standard care only control group. Outcome measures (pain, disability, affect, stress) were assessed at baseline, 2 months following treatment (2‐month follow‐up), and at 5‐month, and 15‐month follow‐ups. A manipulation check demonstrated that, as expected, both types of emotional disclosure led to immediate (post‐session) increases in negative affect compared with arthritis information. Outcome analyses at all three follow‐ups revealed no clear pattern of effects for either clinician‐assisted or private emotional disclosure compared with the two control groups. There were some benefits in terms of a reduction in pain behavior with private disclosure vs. clinician‐assisted disclosure at the 2‐month follow‐up, but no other significant between group differences. We conclude that verbal emotional disclosure about stressful experiences, whether conducted privately or assisted by a clinician, has little or no benefit for people with RA.

Linguistic Analysis of Affective Speech in Psychotherapy: A case grammar approach

The Computer Assisted Language Analysis System (CALAS) was used to examine the relationship of various linguistic measures to outcome measures in high and low verbalized affect segments of 32 patients in psychotherapy. Results indicated that in the high affect segments, therapists with poor outcome cases used more “cognitive” verbs than therapists with good outcome cases. Therapists in general differed from patients by speaking with a more differentiated pattern of speech in both the high and low affect segments. Specifically, therapists used relatively more stative verbs in high affect segments and more action verbs in low affect segments than patients. Therapists also included more information in their speech, but spoke more efficiently (i.e., fewer embedded clauses) than patients. It is suggested that lexical measures may supplement existing measures in the study of psychotherapy dialogue. Das computergestutzte Sprachanalysesysesystem (CALAS) wurde eingesetzt, um die Beziehung verschiedener linguistisc...

An investigation of psychoeducational interventions about therapy

Abstract This study assessed the effects of psychoeducational interventions on undergraduates’ expectations and fears about psychotherapy. Block randomization was used to determine intervention assignment: a multimedia program, information-only presentation, or a no-intervention control group. Pre- and postintervention scores from the Expectations About Counseling–Brief Form (EAC-B) and Thoughts About Psychotherapy Survey (TAPS) were assessed for changes in expectations and fears. Results showed that the multimedia and information-only interventions significantly reduced fears about therapy, although the reduction in fears by the multimedia program was more significant compared with the information-only intervention. The multimedia program also significantly and positively influenced 3 EAC-B subscales, Client Characteristics, Client Attitudes and Behaviors, and Counseling Process and Outcome, compared with the other 2 conditions. Clinical implications of using educational interventions are discussed.

CREATIVE USE OF INTERPERSONAL SKILLS IN BUILDING A THERAPEUTIC ALLIANCE

The therapeutic alliance has emerged as one of the more important and lasting constructs in psychotherapy research. However, the basic interpersonal skills used by therapists to help shape a positive therapeutic alliance are not well understood. We have turned to construct theory to enrich our ongoing empirical and clinical observations of therapists who widely vary in their abilities to form a successful positive alliance. We suggest that creativity in building positive therapeutic alliances includes a vast array of therapist skills, including interpersonal perception, anticipation, experimentation, and revision of interpersonal hypotheses. Two illustrative cases are presented of how the therapists creativity encourages, or alternatively discourages, the clients openness to interpersonal transactions in therapy and the development of a positive working alliance.

Therapist facilitative interpersonal skills and training status: A randomized clinical trial on alliance and outcome

Abstract Objectives: Therapist effects, independent of the treatment provided, have emerged as a contributor to psychotherapy outcomes. However, past research largely has not identified which therapist factors might be contributing to these effects, though research on psychotherapy implicates relational characteristics. The present Randomized Clinical Trial tested the efficacy of therapists who were selected by their facilitative interpersonal skills (FIS) and training status. Method: Sixty-five clients were selected from 2713 undergraduates using a screening and clinical interview procedure. Twenty-three therapists met with 2 clients for 7 sessions and 20 participants served in a no-treatment control group. Results: Outcome and alliance differences for Training Status were negligible. High FIS therapists had greater pre–post client outcome, and higher rates of change across sessions, than low FIS therapists. All clients treated by therapists improved more than the silent control, but effects were greater with high FIS than low FIS therapists. From the first session, high FIS therapists also had higher alliances than low FIS therapists as well as significant improvements on client-rated alliance. Conclusions: Results were consistent with the hypothesis that therapists’ common relational skills are independent contributors to therapeutic alliance and outcome.