Project

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Microtuning a bonafide treatment for GAD patients - A randomized controlled trial

Applicant Flückiger Christoph
Number 136937
Funding scheme Ambizione
Research institution Psychologisches Institut Universität Zürich
Institution of higher education University of Zurich - ZH
Main discipline Psychology
Start/End 01.11.2011 - 28.02.2015
Approved amount 450'150.00
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All Disciplines (2)

Discipline
Psychology
Neurology, Psychiatry

Keywords (3)

generalized anxiety disorder; psychotherapy research; resource activation

Lay Summary (English)

Lead
Lay summary

State of research: This research project’s thematic core is the study of the psychotherapy process and outcome of cognitive behavioral treatments with patients who suffer from general anxiety disorder (GAD). There is still little knowledge about why psychotherapy patients in general (and GAD patient in specific) improve or worsen during psychotherapy. Instead of creating more and more new overall treatment-packets in a medical meta-model, the most powerful approach may be to understand and ameliorate already effective psychotherapies. Treatment rationales and manuals allow a relatively high degree of freedom of therapist behavior on how to implement such manuals. One possibility of variation depends upon the quality of therapists’ application of resource-oriented microinterventions during the therapy sessions and how they capitalize on partners and significant relationships.

Main research question: Can a well-introduced cognitive behavioral treatment for patients with GAD be ameliorated by systematized resource-oriented microinterventions on patients and their partners?

Study design: In this 3-year-SNF Ambizione-proposal, three ways of conducting a disorder-specific, cognitive behavioral treatment (Zinbarg et al., 2006) are contrasted using randomized controlled study design: (a) Resource priming based on a resource-oriented case formulation; (b) resource-oriented couple support; and (c) Problem priming based on a disorder-oriented case formulation. A 3 x 4 design is used with one between-subject factor (resource priming vs. resource-oriented couple support vs. problem priming) and one within-subject factor (time: pre, mid, post, follow-up; respectively sess-by-sess assessment analysed by longitudinal hierarchical linear models).

Study population: A total of 78 patients (26 participants in each of the three conditions) with a primary DSM-IV GAD diagnosis will be recruited by means of advertisements in local newspapers and through Internet forums. The therapies will be conducted by advanced cognitive-behavioral therapy trainees at the psychotherapy outpatient clinic in the Department of Psychology at the University of Zurich. The therapists will be trained and supervised by Dr. Zinbarg, Dr. Flückiger, and cognitive-behavioral supervisors that specialize in couples’ therapy. Advanced Master’s students from the Universities of Bern and Zurich will conduct observer-based video ratings.

Intervention: Resource priming and resource-oriented couple support mainly uses the following two/three strategies to foster resource-oriented microinterventions (Flückiger et al., 2010): (a) Assessment: Individual strengths of the patient are systematically documented by an individual case formulation in individuals and in couples at pre and (b) Priming: Immediately before sessions 1 to 5, therapists have a systematic five-minute preparation about how to implement resource-oriented microinterventions in the forthcoming session. (c) Integrating the partners within the resource-oriented couple support condition.

Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
A Single-blinded, Randomized Clinical Trial of How to Implement an Evidence-based Treatment for Generalized Anxiety Disorder [IMPLEMENT] - Effects of Three Different Strategies of Implementation
Flückiger C., Forrer L., Schnider B., Bättig I., Bodenmann G., Zinbarg R.E. (2016), A Single-blinded, Randomized Clinical Trial of How to Implement an Evidence-based Treatment for Generalized Anxiety Disorder [IMPLEMENT] - Effects of Three Different Strategies of Implementation, in EBioMedicine, 3, 163-171.
Irrational Beliefs and Psychological Distress: A Meta-Analysis
Visla A., Flückiger C., Grosse Holtforth M., David D. (2016), Irrational Beliefs and Psychological Distress: A Meta-Analysis, in Psychotherapy and Psychosomatics, 85(1), 8-15.
The Process-Outcome Mindfulness Effects in Trainees (PrOMET) study: protocol of a pragmatic randomized controlled trial.
Christoph Flückiger (2015), The Process-Outcome Mindfulness Effects in Trainees (PrOMET) study: protocol of a pragmatic randomized controlled trial., in BMC Psychology, 1.
The sleeper effect: Artifact or phenomenon – A brief comment on are the parts as good as the whole? A meta-analysis of component treatment studies (Bell, Marcus & Goodlad, 2013).
Flückiger Christoph, Del Re A. C., Wampold B. E. (2015), The sleeper effect: Artifact or phenomenon – A brief comment on are the parts as good as the whole? A meta-analysis of component treatment studies (Bell, Marcus & Goodlad, 2013)., in Journal of Consulting and Clinical Psychology, 83, 438-442.
The sleeper effect: Artifact or phenomenon-A brief comment on Bell et al. (2013).
Christoph Flückiger (2015), The sleeper effect: Artifact or phenomenon-A brief comment on Bell et al. (2013)., in Journal of Consulting and Clinical Psychology, 438.
Wie wichtig ist die Arbeitsallianz? Eine meta analytische Übersicht
Flückiger Christoph, Horvath Adam O., Del Re A.C., Symonds Dianne, Holzer Corinne (2015), Wie wichtig ist die Arbeitsallianz? Eine meta analytische Übersicht, in Psychotherapeut, 1.
Enduring effects of evidence-based psychotherapies in acute depression and anxiety versus treatment as usual at follow-up – A longitudinal meta-analysis
Flückiger Christoph, Del Re A. C., Munder Thomas, Heer Sara S., Wampold Bruce E. (2014), Enduring effects of evidence-based psychotherapies in acute depression and anxiety versus treatment as usual at follow-up – A longitudinal meta-analysis, in Clinical Psychology Review, 34, 367-375.
Exploration von Resilienzen und Ressourcen bei Veränderungssprüngen – Eine Praxis-Anleitung
Flückiger Christoph, Grosse Holtforth Martin, Del Re A. C., Lutz Wolfgang (2014), Exploration von Resilienzen und Ressourcen bei Veränderungssprüngen – Eine Praxis-Anleitung, in Persönlichkeitsstörungen: Theorie und Therapie, 18(4), 235-243.
Mouches volantes: Kognitiv-Verhaltenstherapeutische Perspektive
Flückiger Christoph (2014), Mouches volantes: Kognitiv-Verhaltenstherapeutische Perspektive, in PiD - Psychotherapie Im Dialog, 15(3), 106-109.
Predicting psychotherapy dropouts: A multilevel approach.
Kegel Alexander, Flückiger Christoph (2014), Predicting psychotherapy dropouts: A multilevel approach., in Clinical Psychology & Psychotherapy, advanced online publication, 1.
Ressourcenaktivierung
Flückiger Christoph, Wüsten Günther (2014), Ressourcenaktivierung, Huber, Bern.
The adherence/resource priming paradigm – a randomised clinical trial conducting a bonafide psychotherapy protocol for generalised anxiety disorder (study protocol).
Flückiger Christoph (2014), The adherence/resource priming paradigm – a randomised clinical trial conducting a bonafide psychotherapy protocol for generalised anxiety disorder (study protocol)., in BMC Psychiatry, 14, 49-58.
Unpacking the effects of therapist responsiveness in borderline personality disorder: motive-oriented therapeutic relationship, patient in-session experience and the therapeutic alliance.
Kramer U., Flückiger C., Kolly C., Caspar F., Marquet P., Despaland J.- N., de Roten Y. (2014), Unpacking the effects of therapist responsiveness in borderline personality disorder: motive-oriented therapeutic relationship, patient in-session experience and the therapeutic alliance., in Psychotherapy and Psychosomatics, 83, 386-387.
Assessing common factors in psychotherapy: Psychometric properties of a new time-economic instrument (WIFA-k) | WIFA-k: Ein neues Messinstrument zur zeitökonomischen Erfassung allgemeiner Wirkfaktoren nach Grawe
Von Consbruch Katrin, Flückiger Christoph, Stangier Ulrich, Beutel Manfred E., Herpertz Stephan, Hoyer Jürgen R., Leibing Erik, Leichsenring Falk, Salzer Simone, Strauß Bernhard Michael, Wiltink Jörg (2013), Assessing common factors in psychotherapy: Psychometric properties of a new time-economic instrument (WIFA-k) | WIFA-k: Ein neues Messinstrument zur zeitökonomischen Erfassung allgemeiner Wirkfaktoren nach Grawe, in PPmP Psychotherapie Psychosomatik Medizinische Psychologie, 63(7), 286-289.
Die Bedeutung der Ressourcenaktivierung für die therapeutische Veränderung - weiterführende praktische Implikationen
Flückiger Christoph (2013), Die Bedeutung der Ressourcenaktivierung für die therapeutische Veränderung - weiterführende praktische Implikationen, in Schaller J. (ed.), Deutsche Gesellschaft für Verhaltenstherapie (DGVT), Tübingen, 179.
Efficacy of New Generation Antidepressants: Differences Seem Illusory
Del Re A. C., Spielmans Glen I., Flueckiger Christoph, Wampold Bruce E. (2013), Efficacy of New Generation Antidepressants: Differences Seem Illusory, in PLOS ONE, 8(6), e63509.
Interpersonal differentiation within depression diagnosis: Relating interpersonal subgroups to symptom load and the quality of the early therapeutic alliance
Grosse Holtforth Martin, Altenstein David, Krieger Tobias, Flückiger Christoph, Wright Aidan G C, Caspar Franz (2013), Interpersonal differentiation within depression diagnosis: Relating interpersonal subgroups to symptom load and the quality of the early therapeutic alliance, in Psychotherapy Research, 1.
Resource activation in generalized anxiety disorder: An observer-based microprocess analysis of in-session outcomes
Flückiger C., Zinbarg R. E., Znoj H. J., Ackert M. (2013), Resource activation in generalized anxiety disorder: An observer-based microprocess analysis of in-session outcomes, in Psychotherapy, 1.
Ressourcenorientierte Gesprächsführung - Advanced Practitioner
Flückiger Christoph, Wüsten G. (2013), Ressourcenorientierte Gesprächsführung - Advanced Practitioner, in Schaller J. (ed.), Deutsche Gesellschaft für Verhaltenstherapie (DGVT), Tübingen, 235.
Substance Use Disorders and Racial/Ethnic Minorities Matter: A Meta-Analytic Examination of the Relation Between Alliance and Outcome
Flueckiger Christoph, Del Re Aaron C., Horvath Adam O., Symonds Dianne, Ackert Michael, Wampold Bruce E. (2013), Substance Use Disorders and Racial/Ethnic Minorities Matter: A Meta-Analytic Examination of the Relation Between Alliance and Outcome, in JOURNAL OF COUNSELING PSYCHOLOGY, 60(4), 610-616.
Working along sudden gains - responsiveness on small and subtle early changes and exceptions.
Flückiger Christoph, Grosse Holtforth Martin, Del Re A C, Lutz Wolfgang (2013), Working along sudden gains - responsiveness on small and subtle early changes and exceptions., in Psychotherapy, 50(3), 292-297.
Expanding research designs to the contextual model of psychotherapy. Umbrella document
Fluckger C. (2012), Expanding research designs to the contextual model of psychotherapy. Umbrella document, kumulative Habilitation, Universität Bern.
How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis.
Flückiger Christoph, Del Re A C, Wampold Bruce E, Symonds Dianne, Horvath Adam O (2012), How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis., in Journal of counseling psychology, 59(1), 10-7.
Is the allegiance effect an epiphenomenon of true efficacy differences between treatments? A meta-analysis.
Munder T., Fluckiger C., Gerger H., Wampold B. E., Barth J. (2012), Is the allegiance effect an epiphenomenon of true efficacy differences between treatments? A meta-analysis., in Journal of Counseling Psychology, 1-7.
Is the relation between early post-session reports and treatment outcome an epiphenomenon of intake distress and early response? A multi-predictor analysis in outpatient psychotherapy
Flückiger Christoph, Grosse Holtforth Martin, Znoj Hansjörg Jörg, Caspar Franz, Wampold Bruce E. (2012), Is the relation between early post-session reports and treatment outcome an epiphenomenon of intake distress and early response? A multi-predictor analysis in outpatient psychotherapy, in Psychotherapy Research, 23(1), 1-13.
Is the relation between early post-session reports and treatment outcome an epiphenomenon of intake distress and early response? A multi-predictor analysis in outpatient psychotherapy.
Fluckiger C., Grosse Holtforth M., Znoj H.J., Caspar F., Wampold B. E. (2012), Is the relation between early post-session reports and treatment outcome an epiphenomenon of intake distress and early response? A multi-predictor analysis in outpatient psychotherapy., in Psychotherapy Research, 1-13.
Learning resource activation | Ressourcenaktivierung lernen
Lakatos-Witt Angelika, Flückiger Christoph, Weisensee Lisa, Reinecker Hans S. (2012), Learning resource activation | Ressourcenaktivierung lernen, in Verhaltenstherapie und Verhaltensmedizin, 33(2), 126-138.
Monitoring mindfulness practice quality: An important consideration in mindfulness practice
Del Re Aaron C., Flückiger Christoph, Goldberg Simon Benjamin, Hoyt William T. (2012), Monitoring mindfulness practice quality: An important consideration in mindfulness practice, in Psychotherapy Research, 23(1), 54-66.
Ressourcen- und Stärkenorientierte Psychotherapie
Schär M., Fluckiger C., Grosse Holtforth M. (2012), Ressourcen- und Stärkenorientierte Psychotherapie, in Steinebach C. (ed.), Beltz, Weinheim, 129-137.
Ressourcenaktivierung lernen und lehren
Lakatos A., Fluckiger C., Weisensee L., Reinecker H. (2012), Ressourcenaktivierung lernen und lehren, in Psychotherapie & Verhaltensmedizin, 33(2), 133-149.
Therapist effects in the therapeutic alliance-outcome relationship: A restricted-maximum likelihood meta-analysis.
Del Re A. C., Fluckiger C., Horvath A., Symonds D. (2012), Therapist effects in the therapeutic alliance-outcome relationship: A restricted-maximum likelihood meta-analysis., in Clinical Psychology Review, 32, 642-649.
Two kinds of corrective experiences in action: Big Bang vs. Constant Dripping.
Grosse Holtforth M., Fluckiger C. (2012), Two kinds of corrective experiences in action: Big Bang vs. Constant Dripping., in Castonguay L. G. (ed.), APA Books, Washington, DC, 1-15.
Valuing clients' perspective and the effects on the therapeutic alliance: A randomized controlled study of an adjunctive instruction.
Flückiger Christoph, Del Re Ac, Wampold Bruce E, Znoj Hansjörg, Caspar Franz, Jörg Urs (2012), Valuing clients' perspective and the effects on the therapeutic alliance: A randomized controlled study of an adjunctive instruction., in Journal of counseling psychology, 59(1), 18-26.
Evidence-based treatments for depression and anxiety versus treatment-as-usual: A meta-analysis of direct comparisons
Wampold Bruce E., Budge Stephanie L., Laska Kevin M., Del Re A. C., Baardseth Timothy P., Fluckiger Christoph, Minami Takuya, Kivlighan D. Martin II, Gunn Wade (2011), Evidence-based treatments for depression and anxiety versus treatment-as-usual: A meta-analysis of direct comparisons, in CLINICAL PSYCHOLOGY REVIEW, 31(8), 1304-1312.
Evidence-based treatments for depression and anxiety versus treatment-as-usual: A meta-analysis of direct comparisons
Wampold BE, Budge SL, Laska KM, Del Re AC, Baardseth TP, Fluckiger C, Minami T, Kivlighan DM, Gunn W (2011), Evidence-based treatments for depression and anxiety versus treatment-as-usual: A meta-analysis of direct comparisons, in CLINICAL PSYCHOLOGY REVIEW, 31(8), 1304-1312.
Predicting premature termination within a randomized controlled trial for binge-eating patients.
Flückiger Christoph, Meyer Andrea, Wampold Bruce E, Gassmann Daniel, Messerli-Bürgy Nadine, Munsch Simone (2011), Predicting premature termination within a randomized controlled trial for binge-eating patients., in Behavior therapy, 42(4), 716-25.
Generalisierte Angststörung erkennen und verstehen: Aktuelle Störungsmodelle für die Psychotherapie
Flückiger Christoph, Generalisierte Angststörung erkennen und verstehen: Aktuelle Störungsmodelle für die Psychotherapie, in Psychotherapie im Dialog, 2015(2), 32-38.
Meta analysis
Del Re A. C., Flückiger Christoph, Meta analysis, in Norcross J. C. (ed.), American Psychological Association, Washington, DC, 1.

Collaboration

Group / person Country
Types of collaboration
University of Wisconsin United States of America (North America)
- Publication
Northwestern University, Evanston United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Universität Bern Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
4. Society of Psychotherapy Research Method Workshop Conference (SPR) Talk given at a conference Longitudinal data analysis in Psychotherapy Research 25.08.2014 Trier, Germany Flückiger Christoph;
45. Society of Psychotherapy Research (SPR) Talk given at a conference Long-term efficacy of evidence-based psychotherapies. Is there a sleeper-effect? 25.06.2014 Copenhagen, Denmark Flückiger Christoph;
Placebo effects and Psychotherapy; Brocher Foundation Talk given at a conference Detecting placebo effects in psychotherapy 14.06.2014 Geneva, Switzerland Flückiger Christoph;
28. Deutsche Gesellschaft für Verhaltenstherapie Berliner DGVT-Kongress (DGVT) Talk given at a conference Patienten mit generalisierter Angststörung lachen oft in der Therapie – oft aus Verlegenheit. 26.03.2014 Berlin, Germany Flückiger Christoph;
BrainFair Talk given at a conference Train your Brain - Psychotherapeutische Interventionsprogramme bei Angststörungen. 16.03.2014 Zürich, Switzerland Flückiger Christoph;
Interdisziplinäre Gesellschaft für Psychosomatische Schmerztherapie (IGPS) Talk given at a conference Ressourcenorientierte Therapie (paper) 08.11.2013 Wiesbaden, Germany Flückiger Christoph;
Interdisziplinäre Gesellschaft für Psychosomatische Schmerztherapie (IGPS) Talk given at a conference Ressourcenaktivierung (workshop) 08.11.2013 Wiesbaden, Germany Flückiger Christoph;
13. Schweizerische Gesellschaft für Psychologie (SGP) Talk given at a conference Crossing borders: Ethnic minorities matter? A meta analytic examionation of the alliance-outcome relationship 11.09.2013 Basel, Switzerland Flückiger Christoph;
44. Society of Psychotherapy Research (SPR) Talk given at a conference Shying away: An observer-based microprocess analysis of experiential avoidance and resource activation in outpatients with generalized anxiety spectrum disorder. Firstauthor: H. J. Znoj 12.07.2013 Brisbane, Australia Flückiger Christoph;
1. Deutsche Gesellschaft für Verhaltenstherapie (DGVT) Talk given at a conference Ressourcenaktivierung (workshop) 01.07.2013 Bern, Switzerland Flückiger Christoph;
31. Deutsche Gesellschaft für Psychologie (DGPS) Talk given at a conference Wie robust sind Arbeitsbeziehung und Therapieerfolg ineinander verzahnt? Eine metaanalytische Bestandsaufnahme (paper) 09.05.2013 Trier, Germany Flückiger Christoph;
European Association for Behavioural and Cognitive Therapies (EABCT) Talk given at a conference Predictiong premature termination within a randomized controlled trial for binge-eating patients. 29.08.2012 Geneva, Switzerland, Switzerland Flückiger Christoph;
43. Society of Psychotherapy Research (SPR) Talk given at a conference Disentangling early processes 20.06.2012 Virginia Beach, USA, United States of America Flückiger Christoph;
31. Deutsche Gesellschaft für Psychologie (DGPS) Talk given at a conference Generalisierte Angststörung – Einführung in die deutsche Adaption des Mastery-Anxiety-Worry Manual (workshop) 09.05.2012 Trier, Germany Flückiger Christoph;
62. Lindauer Psychotherapie Wochen (LPTW) Talk given at a conference Ressourcenorientierte Psychotherapie, Morgenvorlesung 13.04.2012 Lindau, Germany Flückiger Christoph;


Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
Klinische Interventionspsychologie - Grundlagen und Konzepte (Seminar an der Universität Bern) Performances, exhibitions (e.g. for education institutions) 08.09.2014 Bern, Switzerland Flückiger Christoph;
Ansätze zur Behandlung generalisierter Angststörungen. Wirksamkeit und Anwendung (Seminar an der Universität Bern) Performances, exhibitions (e.g. for education institutions) 02.03.2014 Universität Bern, Switzerland Flückiger Christoph;
Meta analysen: Kritische Diskussion (Seminar an der Universität Bern) Performances, exhibitions (e.g. for education institutions) 02.09.2013 Bern, Switzerland Flückiger Christoph;
AOC = .275 - Guter Wein in alten Schläuchen? (Seminar an der Universität Bern) Performances, exhibitions (e.g. for education institutions) 02.03.2013 Universität Bern, Switzerland Flückiger Christoph;
Generalisierte Angststörung: Kritische Diskussion (Seminar an der Universität Bern) Performances, exhibitions (e.g. for education institutions) 19.09.2012 Universität Bern, Switzerland Flückiger Christoph;
Basiswissen der Klinischen Psychologie (Vorlesungs-Termine) Talk 05.03.2012 Bern, Switzerland Flückiger Christoph;


Communication with the public

Communication Title Media Place Year
Media relations: print media, online media Ist Dodo-Bird en vogue? punktum. German-speaking Switzerland 2014
Media relations: radio, television Ressourcen in der Psychotherapie Bayrischer Rundfunk (RadioWissen, Dez.2013) International 2013
Media relations: print media, online media Sie sind gefangen in den Sorgen wie im Hamsterrad Tagblatt der Stadt Zürich German-speaking Switzerland 2013
Media relations: print media, online media Wenn Ängste sich im Kreis drehen Zürichsee-Zeitung German-speaking Switzerland 2013
Media relations: print media, online media Psychologie: Die Angst ist immer da Blick am Abend German-speaking Switzerland 2012
Media relations: print media, online media Sich verselbständigende Sorgen Neue Zürcher Zeitung German-speaking Switzerland 2012

Awards

Title Year
Associate Editor of Psychotherapy Research http://www.tandfonline.com/action/aboutThisJournal?show=editorialBoard&journalCode=tpsr20#.UpxqnqUdWD0 2014
Coeditor of Psychotherapie Im Dialog (Pid) https://www.thieme.de/de/pid-psychotherapie-dialog/profil-1876.htm 2014
Editoral Board APA Psychotherapy as European representant http://www.apa.org/pubs/journals/pst/ 2013
Editorial Board APA Journal of Counseling Psychology as European representant http://www.apa.org/pubs/journals/cou/ 2013
Editorial Board Psychotherapy Research http://www.tandfonline.com/action/aboutThisJournal?show=editorialBoard&journalCode=tpsr20#.UpxqnqUdWD0 2013
Venia Docendi der Universität Bern (Habilitation) Titel: Privat Dozent (PD) 2012

Associated projects

Number Title Start Funding scheme
124102 Capitalization in Psychotherapy 01.06.2009 Fellowships for advanced researchers
163702 Design development in randomized clinical trials - Psychological treatment in generalized anxiety 01.08.2016 SNSF Professorships
190083 Design development in randomized clinical trials - Psychological treatment in generalized anxiety 01.08.2020 SNSF Professorships

Abstract

State of research: This research project’s thematic core is the study of the psychotherapy process and outcome of cognitive behavioral treatments with patients who suffer from general anxiety disorder (GAD). There is still little knowledge about why psychotherapy patients in general (and GAD patient in specific) improve or worsen during psychotherapy (e. g., Borkovec & Ruscio, 2001; Hoyer & Goster, 2009; Newman, Castonguay, Borkovec, Fisher, & Nordberg, 2008; Zinbarg, Mashal, Black, & Flückiger, 2010). Instead of creating more and more new overall treatment-packets in a medical meta-model (Wampold, 2001), the most powerful approach may be to understand and ameliorate already effective psychotherapies (Grawe, 1997; Wampold, 2001, 2007). Treatment rationales and manuals allow a relatively high degree of freedom of therapist behavior on how to implement such manuals. One possibility of variation depends upon the quality of therapists’ application of resource-oriented microinterventions during the therapy sessions (Flückiger, Caspar, Grosse Holtforth, & Willutzki, 2009; Flückiger & Grosse Holtforth, 2008a/b) and how they capitalize on partners and significant relationships (Bodenmann, 2004; 2010; Bodenmann et al., 2008; Hahlweg, Grawe-Gerber, Baucom, & Donald, 2010), especially in couples affected by GAD (Durham, Allan, & Hackett, 1997; Zinbarg, Lee, & Yoon, 2007).Main research question: Can a well-introduced cognitive behavioral treatment for patients with GAD be ameliorated by systematized resource-oriented microinterventions on patients and their partners?Study design: In this 3-year-SNF Ambizione-proposal, three ways of conducting a disorder-specific treatment (Zinbarg, Craske, & Barlow, 2006) are contrasted using randomized controlled study design: (a) Resource priming based on a resource-oriented case formulation; (b) resource-oriented couple support; and (c) Problem priming based on a disorder-oriented case formulation. A 3 x 4 design is used with one between-subject factor (resource priming vs. resource-oriented couple support vs. problem priming) and one within-subject factor (time: pre, mid, post, follow-up; respectively sess-by-sess assessment analysed by longitudinal hierarchical linear models). Study population: A total of 78 patients (26 participants in each of the three conditions) with a primary DSM-IV GAD diagnosis will be recruited by means of advertisements in local newspapers and through Internet forums. The therapies will be conducted by advanced cognitive-behavioral therapy trainees at the psychotherapy outpatient clinic in the Department of Psychology at the University of Zurich. The therapists will be trained and supervised by Dr. Zinbarg, Dr. Flückiger, and cognitive-behavioral supervisors that specialize in couples’ therapy. Advanced Master’s students from the Universities of Bern and Zurich will conduct observer-based video ratings.Assessments: The therapies are accompanied by a comprehensive process and outcome assessment. Disorder-specific diagnostics and questionnaires as well as aspects of general functioning will be assessed at pre, 6-week mid and 12-week post assessments, and 6-months follow-up. The therapeutic process will be assessed by post-session reports and by comprehensive minute-by-minute video ratings at session 2, 5 and 8. Intervention: Resource priming and resource-oriented couple support mainly uses the following two/three strategies to foster resource-oriented microinterventions (Flückiger & Wüsten, 2008): (a) Assessment: Individual strengths of the patient are systematically documented by an individual case formulation in individuals and in couples at pre and (b) Priming: Immediately before sessions 1 to 5, therapists have a systematic five-minute preparation about how to implement resource-oriented microinterventions in the forthcoming session. (c) Integrating the partners within the resource-oriented couple support condition. Data Analysis: In order to handle the longitudinal hierarchical data structures (sessions nested within patients; patients nested within therapists) hierarchical linear models will be used for data analysis (Bryk & Raudenbush, 1992).
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