Objective: Several studies have examined mechanism of change within psychotherapy. However, mechanism of change research on depression is scarce. Due to the cognitive features crucial to depression...Show moreObjective: Several studies have examined mechanism of change within psychotherapy. However, mechanism of change research on depression is scarce. Due to the cognitive features crucial to depression, CBT is the most promising treatment approach, yet it still leaves room for improvement. This thesis aims to identify between-patient and within-patient effects of anhedonia, a critical diagnostic criterion in depression associated with psychotherapeutic outcomes. Method: A sample of 139 patients with MDD undergoing outpatient CBT interventions completed the Well-being Index 5 (as a proxy for depression severity), and a single-item measure of anhedonia session-by-session. Data was analyzed employing hierarchical linear models. Results: Hybrid random effect models revealed significant between- and within-patient effects of anhedonia on therapeutic outcomes. Overall levels of anhedonia across sessions, as well as variations in anhedonia session-by-session, were associated with depression severity. Higher average anhedonia was associated with poorer outcomes, and a reduction in anhedonia session-by-sessions was associated with decreased depression severity. The cross-level interaction demonstrated that both between- and within-patient effects were significantly related to the well-being outcome measurement. Conclusion: Results align with previous research on addressing anhedonia more directly within psychotherapy. These results emphasize that trying to reduce anhedonia could be a relevant path for change in depression treatment. Keywords: cognitive-behavioral therapy, anhedonia in depression, mechanisms of change, hybrid random effects modelShow less
Deliberate Practice (DP) is widely associated with positive outcomes in skill-based contexts, prompting an investigation into its role in psychotherapists' management of challenging therapy...Show moreDeliberate Practice (DP) is widely associated with positive outcomes in skill-based contexts, prompting an investigation into its role in psychotherapists' management of challenging therapy scenarios for possible future implications into therapist training. This study delves into the intricacies of challenging therapy situations as recounted by psychotherapists and examines the influence of Deliberate Practice (DP) on the themes of these situations and therapists' sentiments. A total of 254 participants engaged in the study via an online survey, facilitated by various psychotherapy organizations, each representing different therapeutic frameworks. The survey, utilizing a mixed-methods approach, encompassed closed and open-ended questions. Participants DP levels were assessed using the Deliberate Practice Scale, while thematic analysis provided a rich comprehension of the qualitative data. The results indicate that there is no relationship between the number of hours a participant spent in DP and the themes they describe as challenging. Next to this, a relationship between confidence and number of hours in DP was found. The nature of the relationship revealed that the more hours a participant spent in DP, the less confident they were. Participants regardless of their DP engagement, described similar themes as challenging. However, a negative relationship between confidence and DP hours surfaced, prompting speculation about potential explanations such as impostor syndrome, burnout, and perfectionism. This correlation underscores the complexity of psychotherapists' experiences and asks for further in-depth exploration.Show less
