Adele M. Hayes's research while affiliated with University of Delaware and other places

Publications (70)

Article
Written exposure therapy (WET) is a brief, 5-session treatment for posttraumatic stress disorder (PTSD) that aims to improve access to care. WET has been demonstrated to be an efficacious PTSD treatment with lower rates of dropout and noninferior PTSD symptom outcome compared to cognitive processing therapy (CPT), a 12-session, gold-standard treatm...
Chapter
Exposure-based cognitive therapy (EBCT) applies general principles of system change discovered in the science of complex adaptive systems, which are strikingly similar to principles of change in exposure-based therapies and modern learning theory. We illustrate how exposure principles can extend beyond anxiety and related disorders to treat depress...
Article
In the current study, we examined the degree to which sudden gains (large, rapid, and stable symptom reduction in a one-session interval) predicted treatment outcome in adults randomized to two different trauma-focused treatments. Adults diagnosed with PTSD were randomized to either written exposure therapy (WET; n = 63), a brief, exposure-based tr...
Article
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an effective treatment for children impacted by trauma, and non-offending caregivers play an important role in this treatment. This study aims to identify correlates of four caregiver variables that have been identified as predictors of child outcomes in TF-CBT: support, cognitive-emotional pr...
Article
In this study, we examined processes of change in trauma-focused cognitive behavioral therapy (TF-CBT) delivered to a community sample of 81 youths. Emotional processing theory (EPT) is used as an organizational framework. EPT highlights activating and changing pathological trauma-related responses and increasing adaptive responses across cognitive...
Chapter
The study of mediation and mechanisms is essential to the field of clinical psychology, and yet there remains a great deal of confusion over the best way to study them. This chapter describes traditional approaches to the study of mediation and mechanisms as a foundation for then presenting more innovative approaches that open new possibilities for...
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Background: A growing body of research highlights the limitations of traditional methods for studying the process of change in psychotherapy. The science of complex systems offers a useful paradigm for studying patterns of psychopathology and the development of more functional patterns in psychotherapy. Some basic principles of change are presente...
Chapter
Psychotherapy research has a long history, ranging from qualitative descriptions of its processes, to clinical trials, to more recent analyses of symptoms and processes in individual time course data. As Goldfried (2018) laments, however, this research has been conducted for over a century and there is still no clear consensus on the core principle...
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Objective: This study aimed to identify differential patient change processes and mechanisms associated with long-term outcome in exposure-based cognitive therapy (EBCT) and cognitive-behavioral therapy (CBT) for depression. Method: We drew on a randomized controlled trial in which 149 patients were randomly assigned to either EBCT or CBT, with...
Article
Objective: The sudden gain (SG; large symptom improvements in one between-session interval) has been identified as a consistent predictor of better outcomes at posttreatment and over follow-up in cognitive-behavioral therapy (CBT) for depression. Other defined trajectories of symptom change in CBT, including linear (consistent changes in depressio...
Article
Recent clinical research suggests that facilitating psychological flexibility and emotional processing and decreasing rumination and avoidance are important tasks of treatment for disorders characterized by entrenched patterns of psychopathology, such as major depressive disorder. The current study examined these processes as predictors of treatmen...
Article
Dropout rates in trauma-focused treatments for adult posttraumatic stress disorder (PTSD) are high. Most research has focused on demographic and pretreatment predictors of dropout, but findings have been inconsistent. We examined predictors of dropout in cognitive processing therapy (CPT) by coding the content of trauma narratives written in early...
Article
Objective: Premature dropout is a significant concern in trauma-focused psychotherapy for youth. Previous studies have primarily examined pre-treatment demographic and symptom-related predictors of dropout, but few consistent findings have been reported. The current study examined demographic, symptom, and in-session process variables as predictor...
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Background: Emotional processing (EP) is hypothesized to be a key mechanism of change in psychotherapy that may enhance its long-term efficacy. To study the effects of fostering EP in psychotherapy for depression, this randomized-controlled clinical trial compares the efficacy and pattern of change of a cognitive–behavioral therapy that integrates...
Article
Symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder are the most frequently co-occurring problems following potentially traumatic events. It is unclear whether these comorbidities represent two correlated but distinct disorders or a common post-event response. We sought to inform this question by examining the distinctive...
Article
The aim of the present study was to develop a Polish version of the Inventory of Cognitive Affect Regulation Strategies (ICARUS) and to examine its psychometric properties in a sample of trauma-exposed individuals. The fidelity of instrument translation was assessed in bilingual retests with 103 undergraduate students of English philology. Psychome...
Article
Objective: Involving caregivers in trauma-focused treatments for youth has been shown to result in better outcomes, but it is not clear which in-session caregiver behaviors enhance or inhibit this effect. The current study examined the associations between caregiver behaviors during Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and youth co...
Article
Although there is substantial evidence to support the efficacy of cognitive-behavioral treatments (CBT) for posttraumatic stress disorder (PTSD), there is some debate about how these treatments have their effects. Modern learning theory and cognitive and emotional processing theories highlight the importance of reducing avoidance, facilitating the...
Article
Objective: Sudden gains were investigated in cognitive-behavioral therapy (CBT) for treatment-resistant depression (TRD). Client and therapist processes in sessions proximal to sudden gains were examined to better understand the antecedents of sudden gains and potential mechanisms linking them to outcome. Method: Participants were 156 adults wit...
Article
Rumination has been consistently associated with the development and maintenance of a variety of psychological disorders. While recent research has investigated a number of strategies to counter rumination and its negative effects, few have investigated their efficacy outside of a clinical or laboratory context. The current study used a daily diary...
Article
The science of dynamic systems is the study of pattern formation and system change. Dynamic systems theory can provide a useful framework for understanding the chronicity of depression and its treatment. We propose a working model of therapeutic change with potential to organize findings from psychopathology and treatment research, suggest new ways...
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Inhibition of fear generalization with new learning is an important process in treatments for anxiety disorders. Generalization of maladaptive cognitions related to traumatic experiences (overgeneralized beliefs) have been demonstrated to be associated with posttraumatic stress disorder (PTSD) in adult populations, whereas more balanced, accommodat...
Article
Even with the best psychosocial and pharmacological treatments for unipolar depression, relapse is a serious problem. One path to improve treatments for depression is to target fundamental processes that go awry in depression and to enhance new learning by adapting principles and strategies from exposure-based treatments for anxiety and fear-relate...
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Clinical trials of treatments for personality disorders can provide a medium for studying the process of therapeutic change with particularly entrenched and self-perpetuating systems and might reveal important principles of system transition. We examined the extent to which maladaptive personality patterns were destabilized in a trial of cognitive...
Article
Expressive writing (EW) can be a useful supplement to psychotherapy, regardless of therapeutic orientation. In an open trial of exposure-based cognitive therapy for depression, 43 participants used EW before each session, producing 928 EW samples. Using examples from these, we discuss how EW can be used to both promote and track therapeutic change....
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The current investigation examined the effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in treating child traumatic stress when implemented in community settings on a state-wide level. Seventy-two youths (ages 7-16 years) with a history of documented trauma (sexual or physical abuse, traumatic loss, domestic or community violen...
Article
Researchers often debate about whether there is a meaningful differentiation between psychological well-being and subjective well-being. One view argues that psychological and subjective well-being are distinct dimensions, whereas another view proposes that they are different perspectives on the same general construct and thus are more similar than...
Article
Stress generation research has historically examined the link between depression and stressful life events, particularly interpersonal events. Stress generation theory has rarely been applied to personality disorders, which are characterized by longstanding, pervasive, and often self-perpetuating interpersonal difficulties. In addition, there is li...
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Self-esteem variability is often associated with poor functioning. However, in disorders with entrenched negative views of self and in a context designed to challenge those views, variable self-esteem might represent a marker of change. We examined self-esteem variability in a sample of 27 patients with Avoidant and Obsessive-Compulsive Personality...
Article
The depressive realism hypothesis holds that depressed individuals often make more accurate assessments of reality than nondepressed individuals. Previous depressive realism studies have not examined history of depression separately from current dysphoric mood and have been criticized for lacking external validity and an objective standard for meas...
Chapter
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After 5 years of conceptualizing, investigating, and writing about corrective experiences (CEs), we (the authors of this chapter) met to talk about what we learned. In this chapter, we summarize our joint understanding of (a) the definition of CEs; (b) the contexts in which CEs occur; (c) client, therapist, and external factors that facilitate CEs;...
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Cluster C personality disorders are prevalent in outpatient samples, highly comorbid with Axis I disorders, and can worsen the course of Axis I pathology and treatment outcomes. Cognitive therapy for personality disorders (CT-PD) can be a potent treatment, but establishing and navigating the therapeutic alliance can be especially difficult with thi...
Article
This article recommends an alternative method for testing multifaceted constructs. Researchers often have to choose between two problematic approaches for analyzing multifaceted constructs: the total score approach and the individual score approach. Both approaches can result in conceptual ambiguity. The proposed bifactor model assesses simultaneou...
Article
We combined informant reports and daily diary surveys to examine the associations between depression, interpersonal competence, and daily stress generation. College students completed measures of past and current depression, interpersonal competence, and a 7-day diary of daily negative events. Informants completed reports of participants' interpers...
Article
With the mounting evidence for mindfulness training as a promising strategy for distress reduction across clinical and nonclinical populations, it is important to learn more about the kinds of changes associated with this training. In an exposure-based cognitive therapy for depression that includes mindfulness training, participants reported signif...
Chapter
Chapter 16 describes methods for capturing the process of change, and how researchers can study the shape and process of change using both individual- and group-level data within the open trial and the full-scale RCT design. It also illustrates how process research is an integral part of treatment development.
Article
This online resource provides both conceptual and practical information for conducting and evaluating evidence-based outcome studies. It encompasses psychotherapy research for traditional mental health disorders (eg. depression, anxiety), as well as psychosocial-based treatments provided to medical patient populations to have impact either on the d...
Article
As the number of psychotherapies with demonstrated efficacy accumulates, an important task is to identify principles and processes of change. This information can guide treatment refinement, integration, and future development. However, the standard randomized control trial (RCT) design can limit the questions that can be asked and the statistical...
Article
The study of discontinuities and nonlinear change has been a fruitful endeavor across the sciences, as these shifts can provide a window into the organization of complex systems and the processes that are associated with transition. A common assumption in psychotherapy research has been that change is gradual and linear. The research designs and st...
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As interest grows in mindfulness training as a psychosocial intervention, it is increasingly important to quantify this construct to facilitate empirical investigation. The goal of the present studies was to develop a brief self-report measure of mindfulness with items that cover the breadth of the construct and that are written in everyday languag...
Article
There is now consistent evidence to support the efficacy of cognitive-behavior therapy (CBT) to reduce clinical symptoms and improve quality of life across a variety of clinical problems (Butler, Chapman, Formen, & Beck, 2006). This outcome research typically relies on a pretreatment-posttreatment design and follow-up assessments at fixed intervals...
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Significant shifts or discontinuities in symptom course can mark points of transition and reveal important change processes. The authors investigated 2 patterns of change in depression-the rapid early response and a transient period of apparent worsening that the authors call a depression spike. Participants were 29 patients diagnosed with major de...
Article
The ability to regulate emotions is important to mental health and well-being. However, relatively little is known about the cognitive strategies people use when faced with negative affect and the extent to which these strategies reduce such affect. This may be due, in part, to the lack of a comprehensive measure of cognitive affect-regulation stra...
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Participants were 30 adult outpatients diagnosed with avoidant personality disorder or obsessive-compulsive personality disorder who enrolled in an open trial of cognitive therapy for personality disorders. Treatment consisted of up to 52 weekly sessions. Symptom evaluations were conducted at intake, at Sessions 17 and 34, and at the last session....
Article
The Measure of Mental Anticipatory Processes (MMAP) is a questionnaire measuring patterns of mental preparation that are productive (plan rehearsal and problem analysis) and unproductive (stagnant deliberation and outcome fantasy) in coping with future stressful events. In a series of psychometric studies, the four subscales demonstrated acceptable...
Article
Depression is a leading cause of disability worldwide and can worsen the course of a variety of medical illnesses. There is a clear need to develop more potent treatments for this debilitating disorder and prevent its return. We are developing a promising psychotherapy that integrates components of current, empirically supported therapies for depre...
Article
Bishop et al. (this issue) propose an operational definition of mindfulness developed by a recent consensus panel. The group provides a solid empirical framework from which to develop measures of mindfulness, and they propose an exciting research agenda. We describe measurement development work from our research group that provides initial support...
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Self-esteem (SE) variability has been shown to prospectively predict symptoms of depression. We examined four potential contributors to SE variability (limited sources of self-esteem, defectiveness, negative generalization, and adverse events). College students with and without a history of depression symptoms completed ratings of current self-este...
Article
This study examined the effects of a cognitive–behavioral stress management (CBSM) intervention vs. a no-treatment control group in 100 HIV-infected gay men. CBSM participants showed significant decreases in mood disturbance and depressive symptoms as well as changes in coping, perceptions of social support, self-efficacy, and dysfunctional attitud...
Article
Coinfection with herpes simplex virus type 2 (HSV-2) is common in individuals infected with human immunodeficiency virus (HIV) and may have health implications. This study examined the effect of a 10-week cognitive behavioral stress management (CBSM) intervention on immunoglobulin G (IgG) antibody titers to HSV-2 in a group of mildly symptomatic HI...
Article
Research indicates that depressed individuals are especially likely to engage in thought suppression in an attempt to achieve mental control over the thoughts that threaten their emotional well-being. In this report, we examine the process and problems of thought suppression and offer several strategies designed to enhance mental control. Strategie...
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Dynamic systems theory provides a conceptual framework for the study of change in psychotherapy that is consistent with that used in other sciences. A dynamic systems model of change was proposed and evaluated in the context of cognitive therapy for depression. Consistent with this model, less client protection and more destabilization of depressiv...
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This study compared therapeutic foci in a sampling of 30 cognitive-behavioral and 27 psychodynamic-interpersonal manual-driven treatments for depression. High- and low-impact sessions were coded for each client, with the Coding System of Therapeutic Focus. Results indicated that psychodynamic-interpersonal sessions focused more on such variables as...
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W.B. Stiles and D.A. Shapiro (1994) present a provocative argument that the yield of process research has been minimal because of researchers' overreliance on the drug metaphor and its corollary, the correlational design. Although Stiles and Shapiro raise excellent points regarding the possible misinterpretations of correlational research, their co...
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W. B. Stiles and D. A. Shapiro (1994) present a provocative argument that the yield of process research has been minimal because of researchers' overreliance on the drug metaphor and its corollary, the correlational design. Although Stiles and Shapiro raise excellent points regarding the possible misinterpretations of correlational research, their...
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The ability of several process variables to predict therapy outcome was tested with 30 depressed clients who received cognitive therapy with or without medication. Two types of process variables were studied: 1 variable that is unique to cognitive therapy and 2 variables that this approach is assumed to share with other forms of treatment. The clie...
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I. H. Gotlib and C.L. Hammen's (1992) psychopathology model of depression was used as a conceptual framework for studying the process of change in an effective course of cognitive therapy (CT) for depression. Archived CT transcripts from 30 depressed outpatients in the Cognitive-Pharmaco-therapy Treatment project (S. D. Hollon et al., 1992) were st...
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The goal of this study was to provide a detailed analysis of the focus of therapist interventions in cognitive therapy for depression. Rather than measuring the techniques or specific procedures used by therapists, this study aimed at describing the aspects of clients' functioning targeted by the interventions. A transtheoretical coding system was...
Article
Some studies suggest that excessive interpersonal and achievement concerns (1) create vulnerability to depression in response to specifically congruent negative stressors, and (2) are related to specific constellations of symptoms among subjects who are depressed. We tested both hypotheses together in one prospective study of students, using Beck's...
Article
This review describes the development of cognitive therapy (CT) for depression in the 1960s and 1970s and its application to diverse clinical populations. The question of how CT works, in terms of both active therapeutic ingredients and mechanisms of change within the individual, is addressed. The limitations of CT are discussed, as well as recent...
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Transcripts of sessions conducted by A. T. Beck, D. M. Meichenbaum, and H. H. Strupp with a 40-yr-old man presenting with depression were rated according to the Coding System of Therapeutic Focus (M. R. Goldfried, 1989). For Beck (cognitive therapy), the cognitive triad focus of the therapy was supported. Beck focused more than Meichenbaum and Stru...
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Using a coding system designed to assess therapists' in-session focus, we conducted a preliminary investigation of the differential emphasis placed on client's intrapersonal and interpersonal functioning with interim data collected from an outcome study of a cognitive-behavioral (prescriptive) therapy and psychodynamic-interpersonal (exploratory) t...

Citations

... Ten percent of sessions will be randomly selected and assessed for treatment fidelity by an independent ACT therapist using an adapted form of the ACT Treatment Integrity Coding Manual [43]. The random selection of sessions will be stratified according to therapist, phase of the intervention (early, middle or late), and phase of study recruitment (early, middle or late), as previously recommended [44]. Sessions will be assessed on a regular basis throughout the duration of intervention delivery so that therapists can receive ongoing feedback on their intervention delivery. ...
... This disorder takes a long time to treat and it usually involves several traumas (2,3,4). This disorder causes many problems in the personal, social and family areas, employment, increased risk of cardiovascular diseases (CVD) and CVD death ,all of which indicate the importance of this issue (5). The prevalence of lifetime PTSD is about eight percent of the general population and its incidence in the lifetime is 9 to 15 percent, and in addition, 5 to 15 percent of people may experience forms of subclinical PTSD. ...
... Interventions involving caregivers can improve caregivers' ability to support their children during recovery (Cohen et al., 2004;Tutus et al., 2019). Two studies show that caregiver behavior during the trauma processing sessions within the trauma-focused cognitive behavior therapy (Tf-CBT) by Cohen et al. (2016) is associated with in-session child distress (Canale et al., 2022) and predicts symptom change in youth (Yasinski et al., 2016). The latest treatment guidelines for PTSD in childhood and adolescence recommend interventions involving caregivers, as published by the National Institute for Health and Care Excellence [NICE] (2018), and the German-language Society for Psychotraumatology (Deutschsprachige Gesellschaft für Psychotraumatologie [DeGPT]) (Schäfer et al., 2019). ...
... The effects of childhood abuse and trauma can persist into multiple developmental spheres, including in poor academic performance, substance abuse, externalizing disorders, and internalizing disorders/suicide (Alpert et al., 2021;Lombera et al., 2021;Negriff et al., 2021). Research on TF-CBT (Brown et al., 2020;Cohen et al., 2006Cohen et al., , 2017 has indicated its effectiveness in helping with PTSD and trauma-related symptoms in such cases (Alpert et al., 2021;McGuire et al., 2021;Peters et al., 2021). ...
... Influential concepts and terms representing aspects of awareness include insight (Castonguay and Hill, 2007;McAleavey and Castonguay, 2014), knowledge, understanding, emotional processing (Kramer et al., 2015), corrective experience (Castonguay and Hill, 2012), ability to describe patterns, and affective awareness (Høglend and Hagtvet, 2019). These have been presented as important mechanisms of change across a range of therapy orientations (Wampold et al., 2007;Høglend and Hagtvet, 2019), such as psychodynamic therapy (Messer and McWilliams, 2007;Sharpless and Barber, 2012), experiential therapy (Pascual-Leone and Greenberg, 2007), and cognitive behavior therapy (Grosse Holtforth et al., 2007;Hayes A. M. et al., 2012), and in general, as core processes in psychotherapy (see reviews and meta-analysis by Connolly Gibbons et al., 2007;Jennissen et al., 2018). In addition, there is converging evidence that patients' increased awareness is linked to treatment outcome (Connolly Gibbons et al., 2009;Johansson et al., 2010;Kallestad et al., 2010;Kramer et al., 2015;Høglend and Hagtvet, 2019). ...
... This study examined several client variables as predictors of PTSD symptom improvement in WET and CPT by coding narratives from a randomized controlled noninferiority trial comparing these two treatments . We coded narratives written by clients in each treatment condition using an observational coding system, the Change and Growth Experiences Scale (CHANGE; Hayes et al., 2007), to make use of this rich source of data. The CHANGE was used to measure cognitive, emotional, and behavioral variables expressed in the narratives, including overgeneralized beliefs, assimilated beliefs, accommodated beliefs, ruminative processing, negative emotions (during or around the time of the trauma and in the present time frame), and avoidance. ...
... Researchers have started drawing on dynamical systems theory for methods to improve their understanding of the processes of change in psychopathology (Cramer et al., 2016;Gelo & Salvatore, 2016;Hayes & Andrews, 2020). In part, this renewed interest in dynamical systems is due to the rise in studies revealing that changes in psychopathology are often nonlinear (Delignières et al., 2004;Fisher et al., 2011;Hamaker & Wichers, 2017;Hayes et al., 2007;Helmich et al., 2020;Hosenfeld et al., 2015;Molenaar & Campbell, 2009). ...
... This hypothesis is also based on a number of empirical findings. Whereas in their trial comparing Exposure based congnitive therapy (EBCT) (a cognitive therapy with integrated techniques from EFT) with cognitive behavior therapy (CBT) (grosse Holtforth et al., 2019), both EBCT and CBT yielded similarly good outcomes, EBCT fostered greater during-treatment increases in emotional processing than CBT, which was associated with better long-term depression outcome (Gómez Penedo, Coyne, et al., 2020). Also, there is initial evidence that the change of implicit processing measured by implicit associations may reduce the likelihood of relapse in depression as well as in anxiety (Gomez Penedo, Krieger, et al., 2020;van Tuijl et al., 2020). ...
... An exciting endeavor is to explore whether human change processes operate in ways that are similar to those in other living systems. Critical fluctuations and critical slowing have been well-documented to herald transition across a number of systems in nature [20,27,29,30], and some research suggests that early warning signs can be measured in various ways in psychotherapy and that these signals might matter [90]. ...
... The remaining profile consisted of people with moderate levels of depression symptoms (19.7%) who accounted for the majority of dropout. These findings are highly consistent with previous studies finding non-linear trajectories of depression symptoms during mental health interventions [10,36,37]. The present study is among the first to use RMLPA to investigate differential treatment response patterns in a novel DMHI, leveraging a large sample size in combination with a range of sociodemographic and clinical characteristics shown to influence treatment response. ...