title: Psychotherapy integration under scrutiny: investigating the impact of integrating emotion-focused components into a CBT-based approach: a study protocol of a randomized controlled trial.
abstract: This currently recruiting randomized controlled trial investigates the effects of integrating components of Emotion-Focused Therapy (EFT) into Psychological Therapy (PT), an integrative form of cognitive-behavioral therapy in a manner that is directly mirroring common integrative practice in the sense of assimilative integration. Aims of the study are to understand how both, an existing therapy approach as well as the elements to be integrated, are affected by the integration and to clarify the role of emotional processing as a mediator of therapy outcome.
  
  
  
  A total of 130 adults with a diagnosed unipolar depressive, anxiety or adjustment disorder (seeking treatment at a psychotherapy outpatient clinic) are randomized to either treatment as usual (PT) with integrated emotion-focused components (TAU + EFT) or PT (TAU). Primary outcome variables are psychopathology and symptom severity at the end of therapy and at follow up; secondary outcome variables are interpersonal problems, psychological wellbeing, quality of life, attainment of individual therapy goals, and emotional competency. Furthermore, process variables such as the quality of the therapeutic relationship are studied as well as aptitude-treatment interactions. Variables are assessed at baseline, after 8 and 16 sessions, at the end of therapy, after 25 ± 3 sessions, and at 6, 12 and 36 month follow-up. Underlying mechanisms of change are investigated. Statistical analyses will be conducted using the appropriate multilevel approaches, mainly two-level regression and growth analysis.
  
  
  
  The results of this study will indicate whether the integration of emotion-focused elements into treatment as usual increases the effectiveness of Psychological Therapy. If advantages are found, which may be limited to particular variables or subgroups of patients, recommendations for a systematic integration, and caveats if also disadvantages are detected, can be formulated. On a more abstract level, a cognitive behavioral (represented by PT) and humanistic/experiential (represented by EFT) approach will be integrated. It must be emphasized that mimicking common practice in the development and continued education of psychotherapists, EFT is not integrated as a whole, but only elements of EFT that are considered particularly important, and can be trained in an 8-day training plus supervision of therapies.
  
  
  
  ClinicalTrials.gov, NCT02822443 , 22 June 2016, retrospectively registered.
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland. anna.babl@psy.unibe.ch.
authors.forename: Anna
authors.identifier: 0000-0002-9187-1025
authors.initials: A
authors.lastname: Babl
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Grosse Holtforth
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Sara
authors.initials: S
authors.lastname: Heer
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Mu
authors.initials: M
authors.lastname: Lin
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Annabarbara
authors.initials: A
authors.lastname: Stähli
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Dominique
authors.initials: D
authors.lastname: Holstein
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Martina
authors.initials: M
authors.lastname: Belz
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Egenolf
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Eveline
authors.initials: E
authors.lastname: Frischknecht
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Ramseyer
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Regli
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Emma
authors.initials: E
authors.lastname: Schmied
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Flückiger
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Brodbeck
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Berger
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Franz
authors.initials: F
authors.lastname: Caspar
mesh_terms: D000275:Adjustment Disorders / Q000523:psychology / Q000628:therapy*; D000328:Adult; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D016896:Treatment Outcome
keywords: Cognitive-behavioral therapy; Emotion-Focused Therapy; Integration; Psychological Therapy; Randomized Controlled Trial; Self-regulation