Examining Change Mechanisms in Psychotherapy

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

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.

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:

1. The role of common factors:

   1. 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?
   2. Do some common factor variables stand out regarding ability to explain variance in outcome and across outcomes?
   3. 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?

2. The role of specific change mechanisms (affective, cognitive and meta-cognitive):

   1. To what extent do specific change mechanisms predict change in various outcome domains?
   2. Are these specific change mechanisms equally important predictors, or do they vary across treatment or diagnose?

3. 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.

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:

  1. Patient is expected to have poorer prognosis of life quality if not given treatment
  2. It is expected that the patient will benefit from treatment
  3. 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