Childhood depression is a widespread, stable disorder, and recurring disorder (Kovacs, Feinberg, Crouse-Novak, Paulauskas, & Finkelstein, 1984). Cognitive-Behavioral therapy is an empirically supported intervention for the treatment of depression (Weersing & Weisz, 2002; Weisz, McCarty, & Valeri, 2006). CBT for depression is often comprised of cognitive, behavioral, problem-solving, and relational interventions (McCarty & Weisz, 2007). While it is evident that CBT as a whole is efficacious, there exists a dearth of knowledge concerning the specific components within CBT, which contribute to symptom reduction in youth (Kazdin & Weisz, 1998; Kennard et al., 2009). Therefore, the manner in which CBT accomplishes change is not well understood (Shirk & Karver, 2006). Specifically, while cognitive theories assert that interventions targeted at modifying negative cognitions reduce depression (Beck, 1967), few studies, particularly with regards to depressed youth, have addressed this (Stice, Rohde, Seeley, & Gau, 2010). As such, this hypothesis concerning the role of depressogenic cognitions as mediators between certain CBT interventions and symptom reduction remains unsubstantiated (Weersing, Rozenman, & Gonzales, 2009). The current study assessed whether higher levels of cognitive, behavioral, problem solving, and relational components were associated with lower levels of post-treatment depression, as well as whether they were mediated through changes in the cognitive triad, a measure of depressogenic thinking. No studies have assessed the effectiveness of discrete interventions incorporated in CBT treatments for depression in youth, further examining whether noted changes in depression are mediated through cognitions, specifically the cognitive triad. Participants included 40 depressed females, aged 9 to 14, assessed using self-report measures and a diagnostic interview for depression, who engaged in treatment using a manualized group CBT treatment protocol. Results from hierarchical linear models indicated that higher participant cognitive triad scores and higher relational interventions were associated with lower post-treatment depression scores. However, subsequent analyses revealed that higher aggregated behavioral-problem-solving interventions scores were associated with lower post-treatment depression scores, while higher aggregated cognitive-relational intervention scores were associated with higher post-treatment depression scores. Implications, limitations, and recommendations for further areas of research are discussed. / text

Recent literature has emphasized the possible benefits to mindfulness practice. Evidence for a negative relation between mindfulness and pathology has come from validity studies of several newly developed, self-report mindfulness questionnaires. Results illustrate a consistent negative relation between levels of self-report mindfulness and symptoms of depression, negative affect, and anxiety among college-student samples, however this relation has been previously untested within a clinical sample. The first aim of the present study was to explore the relation between mindfulness levels and social anxiety symptoms in a clinical sample diagnosed with social phobia. Because past research has found mindfulness interventions to be successful in reducing ruminative tendencies, and because recent literature suggests that post-event rumination is an important process in the maintenance of social anxiety, post-event rumination was explored as a mediator of the relation between mindfulness and social anxiety. Participants (N = 98) completed the Mindful Attention Awareness Scale (MAAS), the Rumination Questionnaire (RQ), the Fear of Negative Evaluations Brief Form (FNE-B), the Liebowitz Social Anxiety Scale (LSAS), and the Personal Report of Communication Apprehension (PRCA) as part of their participation in a larger, randomly controlled treatment outcome study comparing Virtual Reality Exposure Therapy, a form of Cognitive-Behavioral Group Therapy for Social Phobia, and a wait-list control group. Results illustrated a strong negative relation between mindfulness scores (MAAS) and social anxiety symptoms as measured by the FNE-B and the LSAS (ps < .001). However, post-event rumination levels (RQ) were not related to either mindfulness or social anxiety indicating that in the present sample post-event rumination did not act as a mediator for the relation between mindfulness and levels of social anxiety.

Recent literature has emphasized the possible benefits to mindfulness practice. Evidence for a negative relation between mindfulness and pathology has come from validity studies of several newly developed, self-report mindfulness questionnaires. Results illustrate a consistent negative relation between levels of self-report mindfulness and symptoms of depression, negative affect, and anxiety among college-student samples, however this relation has been previously untested within a clinical sample. The first aim of the present study was to explore the relation between mindfulness levels and social anxiety symptoms in a clinical sample diagnosed with social phobia. Because past research has found mindfulness interventions to be successful in reducing ruminative tendencies, and because recent literature suggests that post-event rumination is an important process in the maintenance of social anxiety, post-event rumination was explored as a mediator of the relation between mindfulness and social anxiety. Participants (N = 98) completed the Mindful Attention Awareness Scale (MAAS), the Rumination Questionnaire (RQ), the Fear of Negative Evaluations Brief Form (FNE-B), the Liebowitz Social Anxiety Scale (LSAS), and the Personal Report of Communication Apprehension (PRCA) as part of their participation in a larger, randomly controlled treatment outcome study comparing Virtual Reality Exposure Therapy, a form of Cognitive-Behavioral Group Therapy for Social Phobia, and a wait-list control group. Results illustrated a strong negative relation between mindfulness scores (MAAS) and social anxiety symptoms as measured by the FNE-B and the LSAS (ps < .001). However, post-event rumination levels (RQ) were not related to either mindfulness or social anxiety indicating that in the present sample post-event rumination did not act as a mediator for the relation between mindfulness and levels of social anxiety.

Depression is an increasingly common health problem among youth. There is growing empirical evidence that CBT is a promising treatment for childhood depression. It remains unclear what treatment-specific effects of CBT contribute to therapeutic gains. Cognitive theories propose that a primary mechanism of change in CBT are cognitive interventions that target depressogenic cognitions regarding the self, world, and future (cognitive triad), which are thought to mediate depression. The effects of cognitive interventions on depressive symptoms are thus hypothesized to be mediated by changes in the cognitive triad. No studies have investigated whether CBT for depressed youth works by treating the cognitive triad through the implementation of cognitive techniques. As part of a larger study analyzing the mechanisms of change in CBT for depressed youth, the purpose of this study was to investigate: (1) whether specific cognitive techniques are related to depressive symptom reduction in youth, and (2) if improvements in depressive symptoms are mediated through the cognitive triad of depressed youth. Participants were 42 girls, aged 8 to 14, who completed a manualized CBT protocol for depression in group format. Girls completed a diagnostic interview for depression and self-report measures assessing the cognitive triad. Group therapy sessions were coded for cognitive interventions. Results indicated a non-significant relation between levels of cognitive interventions and post-treatment depression scores, after controlling for pre-treatment depression. Therefore, tests of mediation were discontinued. Relevant control variables were added to the model to reduce error variance. After controlling for pre-treatment depression, age, presence of learning disorder, mastery of therapeutic skills, and behavioral interventions, cognitive interventions were significantly and positively associated with post-treatment depression. The relation between cognitive interventions and the cognitive triad was non-significant and meditational analyses were discontinued. Exploratory factor analysis revealed four cognitive interventions factors that were consistent with CBT theory. Further analyses revealed that all factors were not significantly related to post-treatment depression. Tests of interactions between cognitive interventions and behavioral interventions, age, and mastery level of therapeutic skills were also non-significant. Implications, limitations, and recommendations for further areas of research are presented. / text

Currently, there is a limited understanding of change mechanisms across all treatment approaches for eating disorders (ED), particularly with regard to group psychotherapy. This presents one of the major obstacles in the development of more effective treatments. The purpose of this study was to extend current understanding of therapeutic processes in group psychotherapy for bulimic disorders. Thirty-one women were randomly assigned to either 16-weeks of Emotion-Focused Therapy (EFT) or Motivation/Education and Skill Building (M/ESB) as part another study at a participating outpatient ED program. The goals of this study were to: (1) evaluate the relationship between in-session processes; (2) compare these processes between two group treatments; (3) examine in-session differences as a function of client activity in group EFT; (4) and identify a pathway to change. As expected, the findings demonstrated that mid therapy emotional arousal was associated with higher levels of insight, and an increase in insight overtime was associated with an increase in therapeutic alliance. Arousal was not positively correlated with alliance. There was a significant interaction between group treatment x time: clients in EFT reported gains in insight overtime, as measured by post-session change measure, whereas clients’ scores in M/ESB did not change over the course of psychotherapy. Alliance increased significantly over the course of therapy in both groups. Contrary to expectations, clients in the EFT group did not report higher levels of arousal compared to the M/ESB group. The limited sample size in the control group precludes firm conclusions about group comparisons. When examining client activity within EFT, the results demonstrated that clients that were actively engaged in the chair-tasks reported higher post-session change scores, arousal, and alliance compared to when they were in the observing role; however, there was a significant upward trend on post-session change scores regardless of the client role. The pathway to change was partially supported: the observer-rated degree of resolution scores predicted a third of variance in post-session change scores; controlling for pre-treatment outcome scores, post-session change scores predicted variance at the outcome on several EDI-3 subscales. These preliminary findings are discussed in the context of psychotherapy process literature, highlighting limitations and future directions.

Currently, there is a limited understanding of change mechanisms across all treatment approaches for eating disorders (ED), particularly with regard to group psychotherapy. This presents one of the major obstacles in the development of more effective treatments. The purpose of this study was to extend current understanding of therapeutic processes in group psychotherapy for bulimic disorders. Thirty-one women were randomly assigned to either 16-weeks of Emotion-Focused Therapy (EFT) or Motivation/Education and Skill Building (M/ESB) as part another study at a participating outpatient ED program. The goals of this study were to: (1) evaluate the relationship between in-session processes; (2) compare these processes between two group treatments; (3) examine in-session differences as a function of client activity in group EFT; (4) and identify a pathway to change. As expected, the findings demonstrated that mid therapy emotional arousal was associated with higher levels of insight, and an increase in insight overtime was associated with an increase in therapeutic alliance. Arousal was not positively correlated with alliance. There was a significant interaction between group treatment x time: clients in EFT reported gains in insight overtime, as measured by post-session change measure, whereas clients’ scores in M/ESB did not change over the course of psychotherapy. Alliance increased significantly over the course of therapy in both groups. Contrary to expectations, clients in the EFT group did not report higher levels of arousal compared to the M/ESB group. The limited sample size in the control group precludes firm conclusions about group comparisons. When examining client activity within EFT, the results demonstrated that clients that were actively engaged in the chair-tasks reported higher post-session change scores, arousal, and alliance compared to when they were in the observing role; however, there was a significant upward trend on post-session change scores regardless of the client role. The pathway to change was partially supported: the observer-rated degree of resolution scores predicted a third of variance in post-session change scores; controlling for pre-treatment outcome scores, post-session change scores predicted variance at the outcome on several EDI-3 subscales. These preliminary findings are discussed in the context of psychotherapy process literature, highlighting limitations and future directions.

Η παρούσα εργασία εστιάζει στην περιγραφή του φωνηεντικού συστήματος των Μιστιώτικων, - μιας Καππαδοκικής ποικιλίας που μιλιόταν στην περιοχή του Μιστί-, όπως αυτό διαμορφώνεται στις μέρες μας από διαφορετικές γενιές ομιλητών σε ένα μικτό προσφυγικό χωριό της Βόρειας Ελλάδας. Επιπλέον, πραγματοποείται μια σύγκριση ανάμεσα στο σημερινό φωνηεντικό σύστημα σε σχέση με το παλαιό της Καππαδοκικής διαλέκτου, όπως το έχει περιγράψει ο Dawkins (1916), και προτείνεται μια υπόθεση, η οποία έχει ως στόχο να εξηγήσει τις διαφορές που αναδεικνύονται μεταξύ τους, λαμβάνοντας υπ’όψιν τους γλωσσικούς μηχανισμούς και την επαφή διαλέκτων. Σύμφωνα με τον Dawkins (1916), το φωνηεντικό σύστημα της Καππαδοκικής διαλέκτου αποτελούνταν από οκτώ φωνήεντα. Εκτός από τα φωνήνετα [i,e,a,o,u], που έχει και η ελληνική, πραγματώνονταν και τα φωνήεντα [y,œ,ɯ], εξαιτιας της επαφής της διαλέκτου με την τουρκική γλώσσα. Αυτά τα φωνήεντα εμφανίζονταν κυρίως σε τούρκικα δάνεια, π.χ. Τ. karı 'γυναίκα'> [karɯ]• T. tütün > ‘καπνό’ [tytyn] (Janse 2009;2015), ενώ η παρουσία τους σε ελληνικές λέξεις ήταν σπάνια. Όμως, σύμφωνα με τα αποτελέσματα της έρευνας, φάνηκε ότι το τωρινό φωνηεντικό σύστημα αποκλίνει σημαντικά από αυτό που περιγράφουν προηγούμενες μελέτες. Τα τούρκικα φωνήεντα [y,œ,ɯ] έχουν σχεδόν εξαφανιστεί, κυρίως από την ομιλία των νέων. Την ίδια στιγμή όμως, ένα νέο φωνήεν έδειξε να έχει ενσωματωθεί στο σύστημα, το φωνήεν [æ], το οποίο εντοπίστηκε στο λόγο τόσο των ηλικιωμένων όσο και των νέων πληροφορητών. Με σκοπό να δωθεί μια εξήγηση για αυτές τις αλλαγές που παρατηρήθηκαν, υποστηρίζουμε ότι είναι αποτέλεσμα διαδικασιών γλωσσικής και διαλεκτικής επαφής. Συγκεκριμένα, θεωρούμε ότι τα φωνήεντα [y,œ,ɯ] βρίσκονται σε μια φάση εξάλειψης εξαιτίας της ενεργοποίησης του μηχανισμου εξομοίωσης, καθώς τα Μιστιώτικα ήρθαν σε επαφή με τα Ελληνικά και τα Ποντιακά μετά την ανταλλαγή των πληθυσμών και τα τούρκικα χαρακτηριστικά θεωρούνται γενικά στιγματιζμένα εδώ και δεκαετίες. Επιπρόσθετα, το φωνήεν [æ] υποθέτουμε ότι μπορεί να έχει υιοθετηθεί ως ένα εξέχων χαρακτηριστικό από την Ποντιακή διάλεκτο, κάτι που επίσης εκλαμβάνεται ως μια άλλη μορφή εξομοίωσης. / The aim of this study is to present the vowel system of Mišotika, –a varierty of Cappadocian that was spoken at Misti-, as it is spoken by different generations in a mixed refugee village in Northern Greece at the present day. Moreover, we compare this vowel system with the Cappadocian vowel system that has been described by Dawkins (1916), and we propose a hypothesis that aims to explain the differences that appear between these hundred years, taking into consideration mechanisms of language and dialect contact. According to Dawkins (1916), the vowel system of Cappadocian dialect consisted of eight vowels. Besides the Greek vowels [i,e,a,o,u], the dialect also had the vowels [y,œ,ɯ], presumably due to contact with the Turkish language. These vowels appeared mainly in Turkish loans, e.g. Turk. karı 'woman'> [karɯ]• Turk. tütün > ‘tobacco’ [tytyn] (Janse 2009;2015), while their presence in Greek words was rare. However, according to the results of our research, the current vowel system diverges significantly from what earlier studies have described. The vowels [y,œ,ɯ] are almost extinct, especially at the casual speech of the young adults. At the same time, a new realisation has emerged, i.e. the vowel [æ], which is evident in the speech of elders and young adults. In order to explain the above changes, we argue that they are result of language and dialect contact processes. In particular, the Turkish vowels [y,œ,ɯ] are in the process of elimination due to mechanism of levelling, as Mišótika has been in contact with Modern Greek and Pontic since the population exchange of the 1920s, and Turkish features were highly stigmatized for many decades. Similarly, the vowel [æ] has been adopted as a salient feature of the Pontic variety, which is also considered as another aspect of levelling.

Mental and emotional health concerns among college students are prevalent and diverse in their symptom presentations. With increasing demands on counseling centers to provide efficient care and to address students with higher acuity or risk for harm, there has been an increased focus on identifying therapeutic targets that underlie a wide breadth of concerns to broaden the scope and impact of mental health services. Psychological inflexibility is one such target and refers to a combination of excessive avoidance of internal experiences coupled with a lack of actions that align with a person’s values. Interventions for psychological inflexibility aim to support people in reducing actions that are mostly about avoiding unwanted thoughts and feelings and actions that involve moving towards chosen values. Such interventions may produce changes in people’s actions in part through helping people notice and label the different roles their actions play in relation to thoughts, feelings, and personal values. However, the skill of noticing and labeling the purposes of one’s actions has not been studied in interventions for psychological inflexibility despite being discussed in theoretical writings. Training this skill may serve as a direct means of reducing psychological inflexibility and as a foundation for other interventions, thus it may be a relevant target in interventions for psychological inflexibility among college students. Given this, the present study developed and tested an intervention focused on noticing and labeling one’s actions as an intervention for psychological inflexibility in a college student sample, as delivered through web and app-based media. The study recruited 106 students with symptoms of depression and anxiety from a medium sized university in the Mountain West of the United States, and then randomly assigned them to either wait for eight weeks or receive a three-week online and app-based training for noticing and labeling avoidant and values-consistent actions. The results of the study indicated short-term effects on symptoms of depression and anxiety for participants who received the online and app-based training as compared with participants who were asked to wait, although both groups showed reductions in symptoms by the end of the study period. Participants did not report changes in the target skill of noticing and labeling their actions although the study did find larger reductions in psychological inflexibility among participants who received the training as compared with those asked to wait. Further, changes in psychological flexibility were related to changes in behavioral activity and life satisfaction, but not life quality. The results raise questions about the necessity of training the ability to notice and label one’s actions as a direct intervention mechanism for psychological inflexibility. The findings also suggest that changing inflexible patterns of behavior may be more important than the capacity to notice such changes. These results are further interpreted in relation to interventions for college student mental and emotional health.

Background: A recent surge in interest for psychedelic-assisted therapy has manifested itself in exponential increases of subject-related academic publications as well as broad media attention. However, a lot is still to be wished for regarding the question of how the therapy actually works. Objective: To map the current empirical literature regarding “mechanisms of change” and corresponding relevant measures of these mechanisms. Method: The present essay is a scoping review. The process involves systematically acquiring relevant literature by conducting a literature search on two different platforms, Pubmed and PsychInfo, in order to extract and map the data seen as relevant to the research question. Results: Putative “mechanisms of change” and associated measures are successfully mapped and presented in a chart as well as in a basic qualitative content-analysis. The content analysis presents three separate categories used to conceptualize different mechanisms of change: Acute subjective experience, psychological flexibility and neural flexibility. Conclusion: Psychedelic-assisted therapy involves a number of complex mechanisms of change which can be studied both from a psychological as well as neurobiological perspective. These mechanisms can be thought to be dependent on processes in the acute subjective experience and consist in the form of increased psychological flexibility. Relevant measures include psychometric instruments that can be well complemented by FMRI-data. In order to gain a better understanding of these processes regarding the way they relate to one another, what moderates their outcome on depressive symptoms and how clinical application is optimized, further research is warranted. / SammanfattningBakgrund: Ett förhöjt intresse för psykedelisk assisterad terapi har på senare tid visat sig i exponentiella ökningar av ämnesrelaterade akademiska publikationer såväl som bred medieuppmärksamhet. Det finns emellertid mycket att önska när det kommer till frågan om hur terapin faktiskt fungerar. Syfte: Att kartlägga den aktuella empiriska litteraturen angående förmodade ”förändringsmekanismer” och motsvarande relevanta mått på dessa mekanismer. Metod: Föreliggande uppsats är en omfattningsgranskning (scoping review). Processen inbergrep systematisk inhämtning av relevant litteratur genom att genomföra litteratursökningar på två olika plattformar, Pubmed och PsychInfo, för att sedan extrahera och kartlägga den data som ansågs relevant för forskningsfrågan. Resultat: Förmodade "förändringsmekanismer" och tillhörande mått kartläggs framgångsrikt och presenteras i såväl tabell som i en grundläggande kvalitativ innehållsanalys. Innehållsanalysen presenterar tre separata kategorier som används för att konceptualisera olika förmodade förändringsmekanismer: Akut subjektiv upplevelse, psykologisk flexibilitet och neural flexibilitet. Slutsats: Psykedelisk assisterad terapi involverar ett antal komplexa förmodade förändringsmekanismer som kan studeras både ur ett psykologiskt såväl som neurobiologiskt perspektiv. Relevanta mått inkluderar psykometriska instrument som väl kan kompletteras med FMRI-data. För att få en bättre förståelse för dessa processer när det gäller hur de förhåller sig till varandra, vad som dämpar deras resultat vid depressiva symtom och hur klinisk tillämpning optimeras, är ytterligare forskning motiverad.

The overall aim of this thesis was to explore therapeutic action in psychoanalytic psychotherapy from different perspectives (patient, therapist, observer), using different methodological approaches (qualitative and quantitative). Study I explores patients’ views of therapeutic action with grounded theory methodology. The results indicated that talking openly in a safe therapeutic relationship led to new relational experiences and expanding self-awareness. Hindering factors included difficulties “opening up” and experiencing something missing in treatment. Study II investigates experienced therapists’ views of therapeutic action. The development of a close and trusting relationship was perceived as the core curative factor. Patients’ fear of closeness hindered treatment from the therapists’ perspective. Study III involves the development and psychometric examination of a new rating scale for patient-therapist attachment (Patient Attachment to Therapist Rating Scale; PAT-RS). Inter-rater reliability was good for three of the subscales (Security, Deactivation, Disorganization), but poor for one (Hyperactivation). Patterns of correlations with other measures suggest construct validity for the reliable subscales. Study IV examines the relationships between secure attachment to therapist, alliance, and outcome. Linear mixed-effects models, controlling for therapist effects, treatment length and patient-rated alliance, indicated that secure attachment to therapist relates to outcome. Further, the unique variance associated with secure attachment to therapist predicted continued gains in functioning during follow-up. The results of this thesis suggest that the development of a secure attachment to the therapist is a central mechanism of therapeutic change. The results are discussed in relation to established notions of therapeutic action in psychoanalytic psychotherapy. Two tentative process models that may be useful for clinical practice and future research are proposed. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: Epub ahead of print.</p>