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Psychotherapy Process Dynamics and Their Relation to Treatment Success Do Not Differ Across Diagnoses.

Lennart Seizer1,2,3, Leonhard Kratzer4, Johanna Löchner1,3

  • 1Department of Clinical Psychology and Psychotherapy for Children and Adolescents, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.

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Summary

Psychiatric patients

Keywords:
ambulatory assessmentdiagnostic categoriesdynamic patternecological momentary assessmentmonitoringpsychotherapytherapy process questionnairetransdiagnostic

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Area of Science:

  • Psychology
  • Psychiatry
  • Clinical Psychology

Background:

  • Psychotherapy research increasingly uses intensive longitudinal monitoring.
  • Dynamic patterns of change in patients are crucial for understanding treatment effectiveness.

Purpose of the Study:

  • To investigate if diagnostic groups show different dynamic process characteristics during psychotherapy.
  • To explore the relationship between within-person process dynamics and clinical improvement.
  • To evaluate the utility of a transdiagnostic approach in psychotherapy research.

Main Methods:

  • 283 psychiatric inpatients (depression, PTSD, dissociative, personality disorders) completed the Therapy Process Questionnaire daily for ~81 days.
  • Calculated eight dynamic process characteristics (variability, autocorrelation, instability, complexity) for each scale.
  • Compared diagnostic groups using ANOVAs and examined associations with clinical improvement.

Main Results:

  • No significant differences in average process characteristics or their change over time were found across diagnostic groups.
  • Idiosyncratic within-person dynamics, not diagnostic categories, appear to dominate psychotherapy processes.
  • Clinical improvement correlated with increased mean levels and decreased variability in positive emotions, mindfulness, insight, and motivation, irrespective of diagnosis.

Conclusions:

  • Psychotherapy process dynamics are largely transdiagnostic, suggesting individual patterns are more informative than diagnostic labels.
  • Measurement-based care should leverage individual process characteristics to guide interventions.
  • A transdiagnostic approach focusing on within-person dynamics may enhance treatment personalization and effectiveness.