Empirical evaluation of the assumptions in identifying evidence based treatments in mental health

Blatt, Sidney J.; Zuroff, David C.

doi:10.1016/j.cpr.2005.03.001

Cited by 199Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychoanalysis and Psychopathology Research

Empirical evaluation of the assumptions in identifying evidence based treatments in mental health

Blatt, Sidney J., Zuroff, David C.·2005·Clinical Psychology Review

DOI 10.1016/j.cpr.2005.03.001

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Abstract

Extensive analyses of data from the remarkably comprehensive data set established by the Treatment of Depression Collaborative Research Program (TDCRP), initiated and conducted by the National Institute of Mental Health (NIMH), enabled us to examine the contributions of three dimensions of the treatment process (type of treatment, aspects of the therapeutic relationship, and patients' pretreatment personality characteristics) to three assessments of therapeutic change (symptom reduction, reduction of vulnerability, and development of adaptive capacities) evaluated at termination and extended follow-up. The most consistent factors predicting therapeutic gain were the quality of the therapeutic relationship and patients' pretreatment personality dimensions. The implications of these findings for clinical practice, training, and research are discussed.

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Patients who were perfectionistic or self-critical before treatment improved less than those with low perfectionism.
“In particular, those patients who were perfectionistic or self-critical before treatment improved less than those with low perfectionism.”
From Efficacy of psychodynamic short-term psychotherapy for depressed breast cancer patients: Study protocol for a randomized controlled trial (2012) · cites this paper as [13]
Patients who were perfectionistic or self-critical found it difficult to relate to their therapists in the time-limited treatment of depression.
“They obviously found it difficult to relate to their therapists in the time-limited treatment of depression.”
From Efficacy of psychodynamic short-term psychotherapy for depressed breast cancer patients: Study protocol for a randomized controlled trial (2012) · cites this paper as [13]
Blatt & Zuroff found that the success of short-term outpatient treatment depended mostly on two factors: the quality of the therapeutic relationship and patients' pretreatment personality.
“Blatt & Zuroff [13] found that the success of short-term outpatient treatment depended mostly on two factors: the quality of the therapeutic relationship and patients’ pretreatment personality.”
From Efficacy of psychodynamic short-term psychotherapy for depressed breast cancer patients: Study protocol for a randomized controlled trial (2012) · cites this paper as [13]

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Emotion, cognition, and representation
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A Fundamental Polarity in Psychoanalysis: Implications for Personality Development, Psychopathology, and the Therapeutic Process
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Cognitive–behavior therapy versus pharmacotherapy: Now that the jury's returned its verdict, it's time to present the rest of the evidence.
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Anaclitic (sociotropic) and introjective (autonomous) dimensions.
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Role of perfectionism and personality disorder features in response to brief treatment for depression.
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Different Kinds of Folks may Need Different Kinds of Strokes: The Effect of Patients' Characteristics on Therapeutic Process and Outcome
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The present status of outcome studies.
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Psychotherapy Research: Methodological and Efficacy Issues
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Vicissitudes Of Life After The Short-term Treatment Of Depression: Roles Of Stress, Social Support, And Personality
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Short- and long-term effects of medication and psychotherapy in the brief treatment of depression: further analyses of data from the NIMH TDCRP
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Science is not a trial (but it can sometimes be a tribulation).
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A psychodynamic approach to the diagnosis of psychopathology.
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Therapist and Patient Factors Influencing the Patient’s Perception of Facilitative Therapeutic Conditions
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Temporal course of change of depression.
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Psychotherapy indications and outcomes
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Psychotherapy Indications and Outcomes
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Severe and mild depression, New York (Basic Books) 1978.
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ENHANCED ADAPTIVE CAPACITIES AFTER BRIEF TREATMENT FOR DEPRESSION
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Transference: How past relationships emerge in the present
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Effectiveness of Long-Term, Intensive, Inpatient Treatment for Seriously Disturbed Young Adults: A Reply to Bein
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Psychotherapy, Theory and Research.
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The efficacy of psychodynamic psychotherapy
Shedler, J. (2010) · American Psychologist · doi:10.1037/a0018378 · Cited by 1,452 · see citing works
Perfectionism as a transdiagnostic process: A clinical review
Egan, S. J., Wade, T. D., & Shafran, R. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.04.009 · Cited by 961 · see citing works
Short-term psychodynamic psychotherapies for common mental disorders
Abbass, A. A., Kisely, S. R., Town, J. M., Leichsenring, F., Driessen, E., de Maat, S. C. M., Gerber, A. J., Dekker, J., Rabung, S., Rusalovs'ka, S., et al. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004687.pub4 · Cited by 334 · see citing works
Empirically Supported Treatment: Recommendations for a New Model
Tolin, D. F., McKay, D., Forman, E. M., Klonsky, E. D., & Thombs, B. D. (2015) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12122 · Cited by 219 · see citing works
A structural–developmental psychodynamic approach to psychopathology: Two polarities of experience across the life span
Blatt, S. J., & Luyten, P. (2009) · Development and Psychopathology · doi:10.1017/s0954579409000431 · Cited by 216 · see citing works
Self-citation
The therapeutic relationship in the brief treatment of depression: Contributions to clinical improvement and enhanced adaptive capacities.
Zuroff, D. C., & Blatt, S. J. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.1.130 · Cited by 209 · see citing works
Self-citation
The Impact of Perfectionistic Self-Presentation on the Cognitive, Affective, and Physiological Experience of a Clinical Interview
Hewitt, P. L., Habke, A. M., Lee‐Baggley, D., Sherry, S., & Flett, G. L. (2008) · Psychiatry · doi:10.1521/psyc.2008.71.2.93 · Cited by 185 · see citing works
Integrating theory-driven and empirically-derived models of personality development and psychopathology: A proposal for DSM V
Luyten, P., & Blatt, S. J. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.09.003 · Cited by 186 · see citing works
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A quality-based review of randomized controlled trials of psychodynamic psychotherapy.
Gerber, A., Kocsis, J., Milrod, B., Roose, S., Barber, J., Thase, M., Perkins, P. S., & Leon, A. (2011) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.08060843 · Cited by 132 · see citing works
Dependency and self-criticism: relationship with major depressive disorder, severity of depression, and clinical presentation
Luyten, P., Sabbe, B., Blatt, S. J., Meganck, S., Jansen, B., Grave, C. D., Maes, F., & Corveleyn, J. M. T. (2006) · Depression and Anxiety · doi:10.1002/da.20272 · Cited by 162 · see citing works
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Short-term psychodynamic psychotherapies for common mental disorders
Abbass, A. A., Hancock, J. T., Henderson, J., & Kisely, S. R. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004687.pub3 · Cited by 140 · see citing works
Perfectionism and coping with daily failures: positive reframing helps achieve satisfaction at the end of the day
Stoeber, J., & Janssen, D. P. (2011) · Anxiety, Stress & Coping · doi:10.1080/10615806.2011.562977 · Cited by 136 · see citing works
Psychodynamic psychotherapy: a systematic review of techniques, indications and empirical evidence.
Leichsenring, F., & Leibing, E. (2007) · Psychology and psychotherapy · doi:10.1348/147608306x117394 · Cited by 118 · see citing works
The relationship of perfectionism, depression, and therapeutic alliance during treatment for depression: latent difference score analysis.
Hawley, L. L., Ho, M., Zuroff, D. C., & Blatt, S. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.5.930 · Cited by 134 · see citing works
Self-citation
Perfectionism Impedes Social Relations and Response to Brief Treatment for Depression
Shahar, G., Blatt, S. J., Zuroff, D. C., KRUPNICK, J. L., & Sotsky, S. M. (2004) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.23.2.140.31017 · Cited by 124 · see citing works
Self-citation
Treatment preferences affect the therapeutic alliance: implications for randomized controlled trials.
Iacoviello, B., McCarthy, K., Barrett, M. S., Rynn, M., Gallop, R., & Barber, J. (2007) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.75.1.194 · Cited by 128 · see citing works
Psychoanalytic theory and cultural competence in psychotherapy.
Tummala–Narra, P. (2016) · American Psychological Association eBooks · doi:10.1037/14800-000 · Cited by 117 · see citing works
The Role of Perfectionism in Daily Self‐Esteem, Attachment, and Negative Affect
Dunkley, D. M., Berg, J., & Zuroff, D. C. (2011) · Journal of Personality · doi:10.1111/j.1467-6494.2011.00741.x · Cited by 112 · see citing works
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Depression research and treatment: Are we skating to where the puck is going to be?
Luyten, P., Blatt, S. J., Houdenhove, B. V., & Corveleyn, J. M. T. (2006) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.12.003 · Cited by 108 · see citing works
Self-citation
Between‐therapist and within‐therapist differences in the quality of the therapeutic relationship: effects on maladjustment and self‐critical perfectionism
Zuroff, D. C., Kelly, A. C., Leybman, M. J., Blatt, S. J., & Wampold, B. E. (2010) · Journal of Clinical Psychology · doi:10.1002/jclp.20683 · Cited by 108 · see citing works
Self-citation
Ability to receive compassion from others buffers the depressogenic effect of self-criticism: A cross-cultural multi-study analysis
Hermanto, N., Zuroff, D. C., Kopala‐Sibley, D. C., Kelly, A. C., Matos, M., Gilbert, P., & Koestner, R. (2016) · Personality and Individual Differences · doi:10.1016/j.paid.2016.04.055 · Cited by 108 · see citing works
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Self-criticism versus neuroticism in predicting depression and psychosocial impairment for 4 years in a clinical sample
Dunkley, D. M., Sanislow, C. A., Grilo, C. M., & McGlashan, T. H. (2008) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2008.09.004 · Cited by 101 · see citing works
Guided self-help versus pure self-help for perfectionism: A randomised controlled trial
Pleva, J., & Wade, T. D. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.08.009 · Cited by 96 · see citing works
Perfectionism, neuroticism, and daily stress reactivity and coping effectiveness 6 months and 3 years later.
Dunkley, D. M., Mandel, T., & Ma, D. (2014) · Journal of Counseling Psychology · doi:10.1037/cou0000036 · Cited by 96 · see citing works
Self-critical perfectionism, experiential avoidance, and depressive and anxious symptoms over two years: A three-wave longitudinal study
Moroz, M., & Dunkley, D. M. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.11.006 · Cited by 89 · see citing works
A randomised controlled trial of face to face versus pure online self-help cognitive behavioural treatment for perfectionism
Egan, S. J., van Noort, E., Chee, A., Kane, R. T., Hoiles, K. J., Shafran, R., & Wade, T. D. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.09.009 · Cited by 101 · see citing works
Conceptualizing and Measuring Self-Criticism as Both a Personality Trait and a Personality State
Zuroff, D. C., Sadikaj, G., Kelly, A. C., & Leybman, M. J. (2015) · Journal of Personality Assessment · doi:10.1080/00223891.2015.1044604 · Cited by 86 · see citing works
Self-citation
Socially Optimized Learning in a Virtual Environment: Reducing Risky Sexual Behavior Among Men Who Have Sex With Men
Read, S. J., Miller, L. C., Appleby, P. R., Nwosu, M. E., Reynaldo, S., Lauren, A., & Putcha-Bhagavatula, A. (2006) · Human Communication Research · doi:10.1111/j.1468-2958.2006.00001.x · Cited by 82 · see citing works
How (Not What) to Prescribe: Nonpharmacologic Aspects of Psychopharmacology
Mintz, D. L., & Flynn, D. F. (2011) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2011.11.009 · Cited by 81 · see citing works
The Role of Personality in Psychotherapy for Anxiety and Depression
Zinbarg, R. E., Uliaszek, A. A., & Adler, J. M. (2008) · Journal of Personality · doi:10.1111/j.1467-6494.2008.00534.x · Cited by 78 · see citing works
Beneath the Surface of the Therapeutic Interaction: the Psychoanalytic Method in Modern Dress
Bucci, W., & Maskit, B. (2007) · Journal of the American Psychoanalytic Association · doi:10.1177/000306510705500412 · Cited by 75 · see citing works
Advancing complex explanatory conceptualizations of daily negative and positive affect: Trigger and maintenance coping action patterns.
Dunkley, D. M., Ma, D., Lee, I. A., Preacher, K. J., & Zuroff, D. C. (2014) · Journal of Counseling Psychology · doi:10.1037/a0034673 · Cited by 73 · see citing works
Self-citation
Self-critical perfectionism and depressive and anxious symptoms over 4 years: The mediating role of daily stress reactivity.
Mandel, T., Dunkley, D. M., & Moroz, M. (2015) · Journal of Counseling Psychology · doi:10.1037/cou0000101 · Cited by 71 · see citing works
Chronic Stress and Attenuated Improvement in Depression Over 1 Year: The Moderating Role of Perfectionism
Békés, V., Dunkley, D. M., Taylor, G., Zuroff, D. C., Lewkowski, M. D., Foley, J. E., Myhr, G., & Westreich, R. (2015) · Behavior Therapy · doi:10.1016/j.beth.2015.02.003 · Cited by 69 · see citing works
Self-citation
A meta-analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research-specific procedures.
Town, J. M., Diener, M. J., Abbass, A. A., Leichsenring, F., Driessen, E., & Rabung, S. (2012) · Psychotherapy · doi:10.1037/a0029564 · Cited by 67 · see citing works
How to measure sustained psychic transformations in long-term treatments of chronically depressed patients: Symptomatic and structural changes in the LAC Depression Study of the outcome of cognitive-behavioural and psychoanalytic long-term treatments
Leuzinger‐Bohleber, M., Kaufhold, J., Kallenbach, L., Negele, A., Ernst, M., Keller, W., Fiedler, M., Hautzinger, M., Bahrke, U., & Beutel, M. E. (2019) · The International Journal of Psychoanalysis · doi:10.1080/00207578.2018.1533377 · Cited by 65 · see citing works
What is DAS self-critical perfectionism really measuring? Relations with the five-factor model of personality and depressive symptoms
Dunkley, D. M., & Kyparissis, A. (2008) · Personality and Individual Differences · doi:10.1016/j.paid.2007.11.022 · Cited by 63 · see citing works
Self‐efficacy as a robust predictor of outcome in guided self‐help treatment for broadly defined bulimia nervosa
Steele, A. L., Bergin, J. L., & Wade, T. D. (2010) · International Journal of Eating Disorders · doi:10.1002/eat.20830 · Cited by 60 · see citing works
The Efficacy of Psychodynamic Psychotherapy
Shedler, J. (2011) · Humana Press eBooks · doi:10.1007/978-1-60761-792-1_2 · Cited by 61 · see citing works
Perfectionism in Anxiety and Depression: Comparisons across Disorders, Relations with Symptom Severity, and Role of Comorbidity
Wheeler, H. A., Blankstein, K. R., Antony, M. M., McCabe, R. E., & Bieling, P. (2011) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2011.4.1.66 · Cited by 60 · see citing works
Psycho-Education and Group Cognitive-Behavioural Therapy for Clinical Perfectionism: A Case-Series Evaluation
Steele, A. L., Waite, S., Egan, S. J., Finnigan, J., Handley, A. K., & Wade, T. D. (2012) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465812000628 · Cited by 56 · see citing works
Long‐term outcome and post‐treatment effects of psychoanalytic psychotherapy with young adults
Lindgren, A., Werbart, A., & Philips, B. (2010) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608309x464422 · Cited by 53 · see citing works
Perfectionism and its relation to overevaluation of weight and shape and depression in an eating disorder sample
Steele, A. L., O’Shea, A. E., Murdock, A., & Wade, T. D. (2010) · International Journal of Eating Disorders · doi:10.1002/eat.20817 · Cited by 51 · see citing works
Is mentalization a common process factor in transference-focused psychotherapy and dialectical behavior therapy sessions?
Goodman, G. (2013) · Journal of Psychotherapy Integration · doi:10.1037/a0032354 · Cited by 57 · see citing works
The Role of Perfectionism in Relation to an Intervention to Reduce Anxious and Depressive Symptoms in Children
Nobel, R., Manassis, K., & Wilansky-Traynor, P. (2011) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-011-0133-5 · Cited by 51 · see citing works
Looking Back Towards the Future: Is It Time to Change the DSM Approach to Psychiatric Disorders? The Case of Depression
Luyten, P., & Blatt, S. J. (2007) · Psychiatry · doi:10.1521/psyc.2007.70.2.85 · Cited by 50 · see citing works
Self-citation
Self-critical perfectionism and lower mindfulness and self-compassion predict anxious and depressive symptoms over two years
Tobin, R., & Dunkley, D. M. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103780 · Cited by 48 · see citing works
Therapist's Autonomy Support and Patient's Self-Criticism Predict Motivation during Brief Treatments for Depression
Zuroff, D. C., Koestner, R., Moskowitz, D. S., McBride, C., & Bagby, R. M. (2012) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2012.31.9.903 · Cited by 43 · see citing works
Self-citation
Clinical action: Introduction to the special section on the action perspective in clinical psychology
Shahar, G. (2006) · Journal of Clinical Psychology · doi:10.1002/jclp.20290 · Cited by 41 · see citing works
Specific Techniques Vs. Common Factors? Psychotherapy Integration and its Role in Ethical Practice
Brown, J. (2015) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.2015.69.3.301 · Cited by 40 · see citing works
The Efficacy of Psychotherapy: Focus on Psychodynamic Psychotherapy as an Example
Levy, K. N., Ehrenthal, J. C., Yeomans, F. E., & Caligor, E. (2014) · Psychodynamic Psychiatry · doi:10.1521/pdps.2014.42.3.377 · Cited by 40 · see citing works
Construction and Preliminary Validation of a Dictionary for Cognitive Rigidity: Linguistic Markers of Overconfidence and Overgeneralization and their Concomitant Psychological Distress
Cohen, S. J. (2011) · Journal of Psycholinguistic Research · doi:10.1007/s10936-011-9196-9 · Cited by 38 · see citing works
L’évaluation et l’efficacité des psychothérapies psychanalytiques et de la psychanalyse
Rabeyron, T. (2020) · L Évolution Psychiatrique · doi:10.1016/j.evopsy.2020.07.003 · Cited by 39 · see citing works
A Pathway to Therapeutic Change: Changes in Self-Representation in the Treatment of Adolescents and Young Adults
Harpaz‐Rotem, I., & Blatt, S. J. (2009) · Psychiatry · doi:10.1521/psyc.2009.72.1.32 · Cited by 37 · see citing works
Self-citation
Changes in Representations of a Self–Designated Significant Other in Long–Term Intensive Inpatient Treatment of Seriously Disturbed Adolescents and Young Adults
Harpaz‐Rotem, I., & Blatt, S. J. (2005) · Psychiatry · doi:10.1521/psyc.2005.68.3.266 · Cited by 37 · see citing works
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Equifinality, Multifinality, and the Rediscovery of the Importance of Early Experiences
Luyten, P., Vliegen, N., Houdenhove, B. V., & Blatt, S. J. (2008) · The Psychoanalytic Study of the Child · doi:10.1080/00797308.2008.11800798 · Cited by 37 · see citing works
Self-citation
ThePsychodynamic Diagnostic Manual: An Effort to Compensate for the Limitations of Descriptive Psychiatric Diagnosis
McWilliams, N. (2011) · Journal of Personality Assessment · doi:10.1080/00223891.2011.542709 · Cited by 36 · see citing works
Personal Standards and Self-Critical Perfectionism and Distress: Stress, Coping, and Perceived Social Support as Mediators and Moderators
Dunkley, D. M., Solomon‐Krakus, S., & Moroz, M. (2015) · Springer eBooks · doi:10.1007/978-3-319-18582-8_7 · Cited by 35 · see citing works
The transdiagnostic process of perfectionism
Egan, S. J., Wade, T. D., & Shafran, R. (2012) · eSpace (Curtin University) · Cited by 35 · see citing works
Two Primary Configurations of Psychopathology and Change in Thought Disorder in Long-Term Intensive Inpatient Treatment of Seriously Disturbed Young Adults
Blatt, S. J., Avi Besser, A., & Ford, R. Q. (2007) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.05111853 · Cited by 34 · see citing works
Self-citation
Die Wirksamkeit psychodynamischer Psychotherapie
Shedler, J. (2011) · Psychotherapeut · doi:10.1007/s00278-011-0819-2 · Cited by 32 · see citing works
Immediate therapist self-disclosure bolsters the effect of brief integrative psychotherapy on psychiatric symptoms and the perceptions of therapists: A randomized clinical trial
Ziv-Beiman, S., Keinan, G., Livneh, E., Malone, P., & Shahar, G. (2017) · Psychotherapy Research · doi:10.1080/10503307.2016.1138334 · Cited by 31 · see citing works
Patients' resilience and distress over time: Is resilience a prognostic indicator of treatment?
Pakalniškienė, V., Viliūnienė, R., & Hilbig, J. (2016) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2016.05.010 · Cited by 30 · see citing works
Combined Effects of Neuroticism and Extraversion
Fang, L., Heisel, M. J., Duberstein, P. R., & Zhang, J. (2012) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e31825bfb53 · Cited by 32 · see citing works
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Authors: Blatt, S. J., & Zuroff, D. C.
Affiliations: Yale University (US)
McGill University (CA)
Corresponding author: Blatt, Sidney J.
ORCID: Zuroff, David C.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2005-06
Volume: 25
Issue: 4
Pages: 459-486
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2005.03.001
OpenAlex: W2158434987
Cited by: 199
References: 135
Citations by year: 2026: 1 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 9 · 2020: 9 · 2019: 9 · 2018: 14 · 2017: 5 · 2016: 9 · 2015: 13 · 2014: 12 · 2013: 6 · 2012: 14
FWCI: 2.30
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: evidence-based treatment, depression treatment, therapeutic relationship, treatment process, therapeutic change, symptom relief, vulnerability reduction, adaptive capacity, treatment outcome predictors
MeSH terms: Mental Disorders, Humans, Interpersonal Relations, Cognitive Behavioral Therapy, Treatment Outcome, Evidence-Based Medicine, Empirical Research

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Empirical evaluation of the assumptions in identifying evidence based treatments in mental health

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