Psychotherapy: Efficacy, Mechanisms of action, Dissemination

Psychotherapy works! Today, this statement is very well supported by a large number of research studies for a wide range of mental disorders. At the same time, this research has shown that the efficacy and mechanisms of action of psychotherapy vary widely in individual cases: Some patients benefit very extensively and quickly, others rather over a longer period of time and some patients benefit little or even not at all. The aim of our research area "Psychotherapy" is therefore to understand and improve therapeutic success and individual treatment outcome. With a focus on anxiety disorders and depression, we are dedicated to researching the effectiveness of treatments, their ways of application, the mechanisms of action, and dissemination into routine care.

Efficacy research

In this research area, we investigate the efficacy and effectiveness of new or optimized forms of treatment for anxiety disorders and depression in clinically-controlled trials. We are also investigating new forms of application of psychotherapy, such as remotely guided exposure through Smart-glasses or the blended treatment as combination of face-to-face psychotherapy with therapeutic smartphone apps.

Exemplary publications:

Pittig, A., Heinig, I., Goerigk, S., Thiel, F., Hummel, K., Scholl, L., Deckert, J. , Pauli, P., Domschke, K., Lueken, U., Fydrich, T., Fehm, L., Plag, J., Ströhle, A., Kircher, T., Straube; B., Rief, W., et al., (2021). Efficacy of temporally intensified exposure for anxiety disorders: A multi-center randomized clinical trial. Depression and Anxiety, 38, 1169-1181. doi: 1002/da.23204

Heinig, I., Knappe, S., Hoyer, J., Richter, J., Arolt, V., Deckert, J. ... Pittig, A. (2023). Effective – and tolerable: Acceptance and side effects of intensified exposure for anxiety disorders. Behavior Therapy, 54, 427-443. doi: 1016/j.beth.2022.11.001

Pittig, A., Hoyer, J., & Noack, R. (2021). Smart-glass guided exposure for anxiety disorders: A proof-of-concept study on usability, clinical feasibility, and their association. Cognitive and Behavioral Practice, 28, 364–378. doi: 1016/j.cbpra.2020.12.003. Preprint: psyarxiv.com/8x7v3

Atik, E., Stricker, J., Schückes, M., & Pittig, A. (2023). Efficacy of a brief blended cognitive behavioral therapy (bCBT) program for the treatment of depression and anxiety in university students: A feasibility trial. JMIR Mental Health, Advanced online publication. doi: 2196/44742

Mechanisms of action

Psychological treatments involve a variety of mechanisms of action, i.e. processes that underlie the efficacy of psychotherapy ("How does psychotherapy work?"). A precise understanding of these mechanisms helps to improve efficacy of treatment. In this research area, we investigate the multiple mechanisms of action in the treatment of anxiety disorders, specifically so-called extinction learning, the violation of threat expectancy, the facilitation of fear-opposite behaviors, and the therapeutic relationship. In a combined approach of controlled and naturalistic treatment studies, our work aims to uncover the contribution of these mechanisms to successful treatment. For this purpose, we carry out real-life exposure exercises together with controlled laboratory measurements.

Exemplary publications:

Pittig, A., Heinig, I., Richter, J. Hollandt, M., Lueken, U., ... et al. (2023). Change of threat expectancy as mechanism of exposure-based psychotherapy for anxiety disorders: Evidence from 8484 exposure exercises of 605 patients. Clinical Psychological Science, 11, 199-217. doi: 1177/21677026221101379

Pittig, A., Trenor, M., LeBeau, R., & Craske, M. G. (2018). The role of associative fear and avoidance learning in anxiety disorders: Gaps and directions for future research. Neuroscience & Biobehavioral Reviews, 88, 117-140. doi: 1016/j.neubiorev.2018.03.015

Pittig, A., van den Berg, L., & Vervliet, B. (2016). The key role of extinction learning in anxiety disorders: Behavioral strategies to enhance exposure-based treatments. Current Opinion in Psychiatry, 29, 39-47. doi: 1097/YCO.0000000000000220

Dissemination into routine care

At the same time, we examine the dissemination of evidence-based psychotherapy, i.e., the transfer of effective treatments in routine care. We specifically focus on attitudes of therapists and barriers in the health care system.

Exemplary publications:

Pittig, A., Kotter, R., & Hoyer, J. (2019). The struggle of behavioral therapists with exposure: Self-reported practicability, negative beliefs, and therapist distress about exposure-based interventions. Behavior Therapy, 50, 353-366. doi: 1016/j.beth.2018.07.003

Pittig, A. & Hoyer, J. (2017). Exposition aus Sicht niedergelassener Verhaltenstherapeutinnen und Verhaltenstherapeuten: Anwendung und systemische Barrieren. Zeitschrift für Klinische Psychologie und Psychotherapie, 46, 223-235. doi: 10.1026/1616-3443/a000441

Rumin, E., Pittig, A., & Hoyer, J. (2019). Bei Angst Exposition? Eine Befragung niedergelassener Psychotherapeutinnen und -therapeuten. DAZ – Deutsche Angst-Zeitschrift der Deutsche Angst-Hilfe e.V., 87.