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Separating the Effects of Improvements and Deteriorations in Mechanisms on Outcome Using the Asymmetric Effects Model
Cent China Normal Univ, Peoples R China.
Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping.ORCID iD: 0000-0002-1890-3959
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linnaeus Univ, Sweden.
2021 (English)In: Journal of counseling psychology, ISSN 0022-0167, E-ISSN 1939-2168, Vol. 68, no 6, p. 696-704Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this article was to introduce the Asymmetric Fixed Effects (AFE) model to psychotherapy mechanisms of change researchers as a novel way of studying the effects of improvements and deteriorations in the candidate mechanism(s) separately. Alliance-outcome research was used to illustrate the possibility of estimating separate effects of improvements and deteriorations in the alliance. Method: Two archival data sets were used. One was from community-based primary care services in Sweden using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and the Working Alliance Inventory-Short form (WAI-S, therapist form) each session with 1,096 patients. The other data set was from a university counseling center in China using the Session Rating Scale (SRS) and the Outcome Rating Scale (ORS) each session with 292 patients. Data were analyzed using the AFE model. Results: The findings indicated that with raw scores, improvements in alliance from one session to the next were followed by lower symptoms/distress scores by the next session, but alliance deteriorations had no effect on next-session symptoms/distress. With alliance deteriorations and improvements defined relative to the samples average linear change over time, improvements, and deteriorations had equal but opposite effects on next session symptom level. Conclusions: Findings confirm the utility of the Asymmetric Fixed Effect model across two cross-national samples in showing that alliance deteriorations and improvements can predict next session symptoms separately at the within-person level. Findings raise new questions regarding the use of detrending in within-patient mechanism of change studies.

Place, publisher, year, edition, pages
AMER PSYCHOLOGICAL ASSOC , 2021. Vol. 68, no 6, p. 696-704
Keywords [en]
working alliance; asymmetric effects; detrending; mechanisms of change; within-person
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:liu:diva-181199DOI: 10.1037/cou0000569ISI: 000713123700006PubMedID: 34383549OAI: oai:DiVA.org:liu-181199DiVA, id: diva2:1613599
Note

Funding Agencies|National Residents Knowledge of Mental Health and Promotion Strategies [16ZDA232]; Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU) Ministry of Education; Key Laboratory of Human Development and Mental Health of Hubei Province, Peoples Republic of China [2019B01]

Available from: 2021-11-23 Created: 2021-11-23 Last updated: 2021-11-23

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Holmqvist Larsson, MattiasFalkenström, Fredrik
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Center for Social and Affective NeuroscienceFaculty of Medicine and Health SciencesPsykiatriska kliniken i LinköpingPsychologyFaculty of Arts and Sciences
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