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Intersession processes in psychotherapy using an ecological momentary assessment approach

English title Intersession processes in psychotherapy using an ecological momentary assessment approach
Applicant Watzke Birgit
Number 200760
Funding scheme Project funding
Research institution Psychologisches Institut Universität Zürich
Institution of higher education University of Zurich - ZH
Main discipline Psychology
Start/End 01.03.2022 - 28.02.2026
Approved amount 540'000.00
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Keywords (8)

randomized controlled trial; psychotherapy; intensive longitudinal data; inter session processes; ecological momentary assessment; cognitive-behavior therapy; depression; process-outcome research

Lay Summary (German)

Welche Prozesse finden bei Psychotherapie-Patientinnen und -Patienten zwischen den Sitzungen statt und welche Rolle spielen diese Prozesse für den Therapieerfolg? Ziel des Projekts ist die Untersuchung von so genannten Intersessionprozessen in Psychotherapien gegen Depression und des Nutzens einer engmaschigen Begleiterhebung mittels Smartphone.
Lay summary

Die Depression ist eine häufige psychische Erkrankung und geht meist mit starker individueller Belastung sowie mit grossen gesellschaftlichen Kosten einher. Psychotherapie ist eine wirksame Behandlung gegen Depression, wobei jedoch Forschungsergebnisse auch nahelegen, dass Psychotherapie noch weiter verbessert werden kann. Neben der Verbesserung der Therapien an sich spielt dabei zunehmend der Transfer von Therapieinhalten in den Alltag eine grosse Rolle. Solche sogenannten Intersessionprozesse sind patientenseitige Gefühle, Gedanken, Interaktionen und Aktivitäten, die sich auf die Therapie und ihre Inhalte beziehen. Diese Prozesse wurden bislang wenig untersucht.

Deshalb untersuchen wir in dieser Studie, welche Intersessionprozesse überhaupt vorkommen und wie diese mit der therapeutischen Arbeit und dem Therapieerfolg in Zusammenhang stehen. Zudem untersuchen wir den zusätzlichen Nutzen einer therapiebegleitenden Befragung zu Symptomen und Intersessionprozessen mittels Smartphone. Beispielhaft werden dabei Depressionsbehandlungen, die dem Konzept der kognitiven Verhaltenstherapie folgen, untersucht.

Unser Projekt verfolgt die Zielsetzung, die Rolle von Intersessionprozessen genauer zu verstehen. Dies kann zu einer Weiterentwicklung der psychotherapeutischen Behandlung von Depression (z. B. durch eine gezielte Gestaltung der Zeit zwischen den Therapiesitzungen) und somit zu einer besseren Versorgung von Patientinnen und Patienten mit Depression beitragen.

Direct link to Lay Summary Last update: 19.01.2022

Responsible applicant and co-applicants


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Associated projects

Number Title Start Funding scheme
167436 Improving care for patients with depressive and anxiety disorders in primary and secondary care 01.12.2017 NRP 74 Smarter Health Care
166009 Effects of telephone-administered cognitive-behavioral relapse prevention for patients with chronic and recurrent depression: A multi-center randomized clinical trial 01.11.2016 Project funding


Background: One of the most promising strategies to improve the efficacy and effectiveness of psychotherapy is to elucidate key processes that contribute to change. Psychotherapy process research has focused on the role of in-session processes for a long time. In recent years, the focus has expanded to include inter-session processes (IPP), i.e., treatment-related experiences and actions that take place between therapy sessions. IPP are believed to bear the potential for continuing and deepening therapeutic work, to transfer therapeutic contents to patients’ natural surroundings, and, ultimately, to be fostered and targeted by low-intensity interventions (e.g., using smartphone applications). Previous research on IPP has begun to contribute to a conceptual understanding of IPPs and to investigate relations between IPP, in-session process, and outcome. However, previous efforts have not yet integrated different theoretical perspectives on IPP and have not yet used the potential of ecological momentary assessment (EMA) to increase statistical power and to give insight in dynamic relations between variables.Objectives: The proposed project aims to use EMA of IPP in addition to cognitive-behavior therapy (CBT) for depression (1) to investigate dynamic relations between patient pre-treatment characteristics, in-session characteristics (i.e., therapist and treatment characteristics), different types of IPP, and treatment outcome. (2) To investigate whether the addition of EMA referring to IPP and mood increases the effects of CBT in contrast to a CBT-only control group. (3) To conduct simulation studies aiming at testing the statistical power and suitability of methods from dynamic latent class structural equation modeling for the analysis of EMA data.Methods: The planned project combines an observational design (EMA of IPP during CBT for depression) nested within a two-armed randomized trial, contrasting CBT + EMA referring to IPP and mood with CBT alone. We plan to include N = 80 outpatients with first time or recurrent major depression and treat them with 20-25 sessions of non-manualized CBT. During treatment, the intervention group will receive two 4-week blocks of twice-daily EMA using their smartphone. Outcome and further variables will be collected at baseline, twice during treatment, at post-treatment, and at 4-month follow-up. Video ratings of therapy sessions will be used to assess in-session processes. Relevance: The project has the potential to increase knowledge about which types of IPP hinder and facilitate change, about what types of interventions are related to IPP, and, thus, to lay the ground for interventional approaches to IPP. Further, our transtheoretical approach to IPP might contribute to further conceptual clarification of IPP. The integration of EMA into the project might generate further insights into the interventional aspect of EMA and about suitable statistical models to use its potential.