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Publications (97)
Objective
The current study investigated bidirectional associations between defense mechanisms and therapeutic techniques in two different psychotherapies for panic disorder (PD). Identifying how technique use facilitates and is facilitated by change in defenses might guide adaptation and improvement of therapies.
Method
Patient defense mechanisms...
Major depression remains an urgent public health challenge with detrimental long-term effects. Despite tremendous scientific progress, most depressed individuals lack access to high-quality psychotherapies, and even when treated, overall response rates remain stagnant. Uncovering the mechanisms underlying change in psychotherapy can guide the devel...
Purpose: Social disconnection is one of the strongest risk factors for postpartum depression (PPD). Prior correlational studies have found an association between perceived social support and PPD. However, it is unclear whether social engagement reduces PPD, and if so, which activities are most beneficial. We examined a scalable psychotherapy aimed...
Importance: Most older adults with depression do not have access to efficacious psychotherapies, due to critical clinician shortage. Even when treated, response rates are limited to about 50%. A Treatment Decision Rule (TDR) can maximize treatment efficacy and resources by assigning patients to their optimal intervention. This is the first study to...
Objectives: Interpersonal problems are a fundamental feature of depression, but study-level meta-analyses of their association with treatment outcome have been limited by heterogeneity in primary studies' analyses and reported results. We conducted a pre-registered individual participant data meta-analysis (IPD-MA) to examine this relationship for...
Objective: Perinatal depression and anxiety are common, underdiagnosed, undertreated, and increase the risk of poor maternal and infant outcomes. There is a need to accurately estimate prevalence and persistence of these disorders to inform development of scalable and timely interventions. We aimed to estimate screening rates, prevalence and persis...
Importance: Postpartum depression (PPD) is common, undertreated, and debilitating for women and infants. There is an urgent need for scalable treatments for PPD. Women with PPD experience disruptions in reward-supported behaviors - reduced behavioral activation and social reward responsivity. Thus, the reward system is a promising target for psycho...
Importance: Postpartum depression (PPD) is common, undertreated, and debilitating for women and infants. There is an urgent need for scalable treatments for PPD. Women with PPD experience disruptions in reward-supported behaviors - reduced behavioral activation and social reward responsivity. Thus, the reward system is a promising target for psycho...
Objectives : Effectiveness of psychotherapy depends on patients’ adherence to between-session homework (HW) to practice therapeutic skills. mHealth apps can offer continuing reminders, although frequent reminders overwhelm or burden patients and therefore are ineffective. Predicting likelihood of completing daily HW and sending contextual reminders...
Abstract
Objective
There is a pervasive underrepresentation of researchers and clinicians from diverse backgrounds in psychology. This is the first study to focus on diversity gaps in Psychotherapy Research. We examine a gap in the representation of research from low-income countries and summarize barriers and solutions to increase diversity in the...
Decades of neuroimaging studies have shown modest differences in brain structure and connectivity in depression, hindering mechanistic insights or the identification of risk factors for disease onset¹. Furthermore, whereas depression is episodic, few longitudinal neuroimaging studies exist, limiting understanding of mechanisms that drive mood-state...
This study aimed to characterize the prevalence of irritability among U.S. adults, and the extent to which it co-occurs with major depressive and anxious symptoms. A non-probability internet survey of individuals 18 and older in 50 U.S. states and the District of Columbia was conducted between November 2, 2023, and January 8, 2024. Regression model...
Intervention studies in psychology often focus on identifying mechanisms that explain change over time. Cross-lagged panel models (CLPMs) are well suited to study mechanisms, but there is a controversy regarding the importance of detrending—defined here as separating longer-term time trends from cross-lagged effects—when modeling these change proce...
The COVID-19 pandemic led to an unprecedented need for mental health support for hospital employees. To address these rising needs, members of the Psychiatry Department of Weill Cornell Medicine/NewYork-Presbyterian Hospital created a brief, behavioral skills-based mental health crisis intervention program termed “CopeNYP.” Due to the success of Co...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
Hundreds of neuroimaging studies spanning two decades have revealed only modest differences in brain structure and functional connectivity in depression, complicating efforts to derive mechanistic pathophysiologic insights or develop biomarkers. Furthermore, although depression is a fundamentally episodic condition, few neuroimaging studies have ta...
Background:
Social rewards (e.g., social feedback, praise, and social interactions) are fundamental to social learning and relationships across the life span. Exposure to social rewards is linked to activation in key brain regions, that are impaired in major depression. This is the first summary of neuroimaging literature on social reward processi...
Background:
Existing literature suggests that patients' experiences of emotions, especially negative emotions, predict outcomes in psychotherapies for major depressive disorder. However, the specific mechanisms underlying this effect remain unclear. Based on studies pointing to the role of oxytocin (OT) in attachment relationships, we proposed and...
Importance:
Approximately half of older adults with depression remain symptomatic at treatment end. Identifying discrete clinical profiles associated with treatment outcomes may guide development of personalized psychosocial interventions.
Objective:
To identify clinical subtypes of late-life depression and examine their depression trajectory du...
Background:
We aimed to characterize the prevalence of social disconnection and thoughts of suicide among older adults in the United States, and examine the association between them in a large naturalistic study.
Methods:
We analyzed data from 6 waves of a fifty-state non-probability survey among US adults conducted between February and December...
Objective:
In psychotherapy, strength-based methods (SBM) represent efforts to build on patients' strengths while addressing the deficits and challenges that led them to come to therapy. SBM are incorporated to some extent in all major psychotherapy approaches, but data on their unique contribution to psychotherapy efficacy is scarce.
Methods:
F...
Objective:
Repetitive transcranial magnetic stimulation (rTMS) protocols increasingly use subgenual anterior cingulate cortex (sgACC) functional connectivity to individualize treatment targets. However, the efficacy of this approach is unclear, with conflicting findings and varying effect sizes across studies. Here, the authors investigated the ef...
Background:
Short-term psychodynamic psychotherapy (STPP) is frequently used to treat depression, but it is unclear which patients might benefit specifically. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses and identify patient-level moderators. This IPD meta-analysis examin...
This cross-sectional study assesses the association between perceived social support and cognitive performance in older adults with depression.
Objective
Older adults are disproportionally impacted by the COVID-19 pandemic, causing a mental health crisis in late life, due to physical restrictions (e.g., quarantine), limited access to services, and lower literacy and access to technology. Despite established benefits, systematic screening of mental health needs of older adults in community...
This study examined whether political climate influenced trainees’ clinical work, supervisory experiences, and supervisory alliance. Data were collected from 366 trainees in a nationwide survey. Most trainees believed that the political atmosphere has affected clients to some degree. Over half reported political dialogue with supervisors, more ofte...
In the past two decades medicine research has shifted its focus to personalization; i.e., identifying which treatments are optimal for specific individuals. This endeavor involves the detection of variables that explain heterogeneity in clinical outcomes across patients who receive the same treatment. In psychotherapy research, matching treatments...
Background: Identifying individual-specific mechanisms of action may facilitate progress toward precision medicine. Most studies seeking to identify mechanisms of action collapse together two distinct components: pre-treatment trait-like characteristics differentiating between individuals and state-like characteristics changing within each individu...
Objective:
Modeling cross-lagged effects in psychotherapy mechanisms of change studies is complex and requires careful attention to model selection and interpretation. However, there is a lack of field-specific guidelines. We aimed to (a) describe the estimation and interpretation of cross lagged effects using multilevel models (MLM) and random-in...
Introduction
Elder abuse afflicts up to 10% of adults 60 years and older, with approximately one third of elder abuse (EA) victims presenting clinically significant depressive symptoms. When offered EA resolution services, victims underutilize them. In collaboration with community partners, we developed PROTECT, Providing Options to Elderly Clients...
Social isolation and loneliness have health consequences that rival those of smoking and obesity. Older adults are at particularly high risk for the negative consequences of loneliness and social disconnection due to compounding effects of age-related declines in functioning, cognition, and sensory function. Up to 29% of adults age 60 and older exp...
Introduction
Processing of monetary and social rewards is inhibited in late-life depression¹. Social isolation predicts depression severity² and poor response to psychotherapy.³ Individuals with smaller social networks are more socially isolated and experience fewer socially rewarding interactions. Engagement in socially rewarding experiences predi...
Objective:
Although clients' hostile behavior directed at therapists (hostile resistance) predicts worse outcomes in cognitive-behavioral therapy (CBT) for panic disorder, the process by which this happens remains unknown. This study examines two putative mechanisms: working alliance and therapist adherence.
Method:
Seventy-one adults with prima...
Late-life depression is heterogenous and patients vary in disease course over time. Most psychotherapy studies measure activity levels and symptoms solely using self-report scales, administered periodically. These scales may not capture granular changes during treatment. We introduce the potential utility of passive sensing data collected with smar...
This study aimed to identify subgroups of depressed older adults with distinct trajectories of suicidal ideation during brief psychotherapy and to detect modifiable predictors of membership to the trajectories of suicidal ideation. Latent growth mixed models were used to identify trajectories of the presence of suicidal ideation in participants to...
Effective psychotherapies for late-life depression are underutilized, mainly because of their complexity. “Engage” is a novel, streamlined psychotherapy that relies on neurobiology to identify core behavioral pathology of late-life depression and targets it with simple interventions, co-designed with community therapists so that they can be deliver...
The study aimed to: (1) Identify distinct trajectories of change in depressive symptoms by mid-treatment during psychotherapy for late-life depression with executive dysfunction; (2) examine if nonresponse by mid-treatment predicted poor response at treatment end; and (3) identify baseline characteristics predicting an early nonresponse trajectory...
Verhaltensaktivierung (Behavioral Activation) ist eine kurze, manualisierte, evidenzbasierte Therapie für depressive Störungen. Ihre Prinzipien basieren auf der Verhaltenstherapie. Manualisierte Verhaltensaktivierungs-Therapien wurden Ende der 1990er-Jahre entwickelt und verbreiteten sich in den frühen 2000er-Jahren 1, 2, 3.
In the midst of the Spring 2020 initial surge of the COVID-19 pandemic in New York, members of the Psychiatry Department of Weill Cornell Medicine/NewYork-Presbyterian Hospital rapidly created and implemented a brief, behavioral skills-based intervention program, “CopeNYP”, to address the immediate mental health needs of the employees of the hospit...
Elder abuse is prevalent, and victims have high rates of depression and low quality of life. We established an academic–community partnership to test the feasibility, acceptability, and impact of a brief psychotherapy for depression (PROTECT) among elder abuse victims with capacity to make decisions. Elder abuse service providers referred depressed...
Objective
Social isolation is highly common in late life and is associated with devastating mental health and physical outcomes. This study investigated whether components of social isolation (marital status, perceived social support, and interpersonal problems) predict change in depression severity over the course of a brief adherence intervention...
Most measures of psychotherapy outcome focus on symptomatic change. However, clients often report other changes through therapy, such as increased self-acceptance. This study reports on the development and validation of the Complementary Measure of Psychotherapy Outcome (COMPO) that assesses different areas of psychological functioning deemed impor...
The introduction of novel methodologies in the past decade has advanced research on mechanisms of change in observational studies. Time‐lagged panel models allow us to track session‐by‐session changes and focus on within‐patient associations between predictors and outcomes. This shift is crucial as change in mechanisms inherently takes place at a w...
Older adults frequently under-report depressive symptoms and often fail to access services after a disaster. To address unmet mental health needs, we developed a service delivery program (SMART-MH) that combines outreach, assessment, and therapy and implemented it in New York City after Hurricane Sandy. This study aimed to examine the feasibility,...
Less than 40% of depressed older adults treated with an antidepressant achieve remission. Incomplete response to treatment is common. Current augmentation strategies have limited efficacy, and many have side effects that restrict their utilization in older adults. We conducted the first open pilot trial of minocycline augmentation in older adults w...
Objective:
The current investigation aimed to examine the possible association between therapists' flexibility in use of therapeutic techniques from different therapy orientations (i.e., therapeutic technique diversity; TTD) and subsequent improvement in client-reported (a) global functioning, as well as (b) quality of the working alliance, follow...
Objective: Existing evidence highlights the importance of modeling differential therapist effectiveness when studying psychotherapy outcome. However, no study to date examined whether this assertion applies to the study of within-patient effects in mechanisms of change. The study investigated whether therapist effects should be modeled when studyin...
Objective
Apathy is common in late-life depression and is associated with poor response to antidepressant drugs. In depressed older adults, apathy may be characterized by neuroanatomical abnormalities of the salience network. The current study examined whether cortical thickness of select salience network structures predicted change in apathy follo...
This is a manual for observer training and coding of the MULTI-60/30.
This document is work in progress and we welcome any suggestions or questions.
The global epidemic of loneliness and social isolation has health consequences that rival those of smoking and obesity. Older adults are at particularly high risk for loneliness, due to age-related declines in functioning and reduction in social networks. There is a need to further understand the effects of loneliness on cognitive, mental, and phys...
Background
Problem solving therapy (PST) and “Engage”, a reward-exposure” based therapy, are important treatment options for late-life depression, given modest efficacy of antidepressants in this disorder. Abnormal function of the reward and default mode networks has been observed during depressive episodes. This study examined whether resting stat...
Objective
Primary care is the de facto mental health system in the US where physicians treat large numbers of depressed older adults with antidepressant medication. This study aimed to examine whether antidepressant dosage adequacy and patient adherence are associated with depression response among middle aged and older adults prescribed with antid...
The alliance is widely recognized as a robust predictor of posttreatment outcomes. However, there is a debate regarding whether the alliance is an epiphenomenon of intake characteristics and/or treatment processes occurring over the course of treatment. This meta-analysis aimed to synthesize the evidence on this issue. We identified 125 effect size...
To examine process of changes in two distinct psychotherapies-cognitive-behavioral therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP). Two hypothesized processes of change-misinterpretation of bodily sensations and Panic Specific Reflective Function (PSRF)-were tested in the CBT and PFPP arms of the Cornell-Penn Study of Psychothera...
Background: Problem solving therapy (PST) and “Engage”, a reward-exposure” based therapy, are important treatment options for late-life depression, given modest efficacy of antidepressants in this disorder. Abnormal function of the reward and default mode networks has been observed during depressive episodes. This study examined whether resting sta...
The primary aim of the current study was to investigate whether therapists’ use of varied techniques drawn from multiple therapeutic orientation facilitates clients’ functioning and alliance experience following alliance ruptures. It thus expands previous works by exploring therapists’ use of techniques drawn from multiple therapeutic approaches si...
Previous studies have shown that individuals with personality disorder (PD) suffer from significant interpersonal distress. Some PDs, such as avoidant personality disorder (AvPD), have been characterized with a clear homogeneous interpersonal profile. Other PDs, such as obsessive-compulsive personality disorder (OCPD), have shown significant hetero...
Objective:
To investigate whether (a) baseline levels of panic-specific reflection function (PSRF; i.e. patients' capacity to reflect on their panic symptoms) and improvement in this capacity over treatment; (b) baseline borderline personality disorder (BPD) traits and pre-post treatment improvement in BPD traits predict change in patients' qualit...
Background:
Late-life depression (LLD) is characterized by network abnormalities, especially within the cognitive control network (CCN). We used alternative functional connectivity approaches, regional homogeneity (ReHo) and network homogeneity (NeHo), to investigate LLD functional homogeneity. We examined the association between CCN homogeneity an...
Clients' emotional experience (EE) and self-understanding (SU) are two clients' processes thought to play a key role in many therapeutic approaches, especially psychodynamic (PD) psychotherapy. Previous studies exploring client processes and the interventions assumed to promote them have found that both processes and interventions are related to a...
Objective
To examine therapists’ perspectives on political self‐disclosure, perceived shared values with patients, and the therapeutic alliance.
Method
Therapists from all US states completed a structured survey (N = 268; 62% Democrats; 7% Republicans; 23% independents; 8% others).
Results
Most therapists (87%) reported they discussed politics in...
Introduction
Late life depression has detrimental effects on older adults’ functioning and well-being. Depressed older adults often experience loneliness and social isolation, which are risk factors for incident depression, increased depression severity, and medical illness. Neurobiological studies suggest that depressed individuals of all ages exh...
Objective: To examine whether working alliance quality and use of techniques predict improvement in Panic-Specific Reflection Function (PSRF), and misinterpretation of bodily sensations in treatments for panic disorder. Method: A sample of 161 patients received either CBT or PFPP (Panic-focused Psychodynamic therapy) within a larger RCT. Data were...
Objective:
Loneliness and social isolation are associated with depressive symptoms, cognitive and physical disabilities, and increased risk of mortality among older adults. Socially rewarding activities reduce loneliness, and neurobiological evidence suggests that these activities may activate neural reward systems in older adults to a greater ext...
Objective
Clinically significant depression occurs in approximately 40% of chronic obstructive pulmonary disease (COPD) patients, and both illnesses severely impair quality of life. This study tests the hypothesis that problem-solving integrated with a treatment adherence intervention, the Problem Solving-Adherence (PSA), is superior to a personali...
Objective:
Given the chronic, episodic nature of panic disorder, it is important to examine long-term outcomes of patients who respond well to various psychotherapies.
Method:
Out of 116 patients with DSM-IV panic disorder who evidenced a ≥ 40% reduction in panic and avoidance symptoms on the Panic Disorder Severity Scale (PDSS) after 12-14 week...
Objective:
This study examines whether, in panic-focused psychodynamic psychotherapy (PFPP), interpretations of conflicts that underlie anxiety (panic-focused or PF-interpretations) are specifically associated with subsequent panic disorder (PD) symptom improvement, over and above the provision of non-symptom-focused interpretations.
Method:
Tec...
The primary aim of this study was to investigate the effects of the 2016 United States presidential election and ensuing political climate on patients' experiences in psychotherapy. A sample of 604 self-described Democrat and Republican patients from 50 states participated in the study. Results showed that most therapists disclosed their political...
Objective:
To develop a brief version of the Multitheoretical List of Therapeutic Interventions (MULTI-60) in order to decrease completion time burden by approximately half, while maintaining content coverage. Study 1 aimed to select 30 items. Study 2 aimed to examine the reliability and internal consistency of the MULTI-30. Study 3 aimed to valid...
Objective:
The aim of this study was twofold: (a) Investigate whether therapists are consistent in their use of therapeutic techniques throughout supportive-expressive therapy (SET) and (b) Examine the bi-directional relation between therapists' use of therapeutic techniques and the working alliance over the course of SET.
Method:
Thirty-seven d...
We review and comment on five articles included in this special issue of
Psychoanalytic Inquiry. Each article addresses potential moderators and
mechanisms of change within psychodynamic psychotherapy. We briefly
present the questions we find most relevant in assessing the research on
the mechanisms of change discussed in each of these articles. We...
The TDCRP was the first NIMH funded multi-site coordinated study in the field of psychotherapy research. It was also the first large-scale trial comparing two psychotherapies, medication, and a placebo control condition. The pioneer and primary investigator of the TDCRP was Irene Elkin, a creative and innovative researcher whose vast contributions...
In the past few decades there has been an increasing movement toward adopting integrative perspectives. Although the levels of psychotherapy integration shown by therapists in naturalistic and experimental settings have been investigated, not much is known about the levels of integration among psychotherapy experts. The current study examines the l...
In the past several decades, increasing evidence supports the efficacy of psychotherapies for depression. The vast majority of findings from meta-analyses, randomized clinical trials (RCTs) and naturalistic studies have demonstrated that well-established psychotherapies (behavioural activation, problem-solving therapy, psychodynamic therapy, cognit...
Most of the literature on the alliance-outcome association is based exclusively on differences between patient reports on alliance. Much less is known about the unique contribution of the therapist's report to this association across treatment, that is, the association between therapist-reported alliance and outcome over the course of treatment, af...
Evaluative conditioning (EC) is a change in the evaluation of a stimulus after the stimulus co-occurred with affective stimuli. The present research examined whether EC of one stimulus depends also on the co-occurrence of another stimulus with positive or negative stimuli. We paired two target people with affective stimuli. We found that a person w...
