Dynamics of Psychotherapy and Treatment Outcomes

Primary outcomes

1. Resilience Level Assessed by the Connor-Davidson Resilience Scale Short Version (CD-RISC-10)

   Time frame: Week 1 (pre-treatment); Week 4 (1 month of treatment); Week 8 (2 months of treatment); Week 12 (post-treatment; end of 3-month therapy cycle)

   Connor-Davidson Resilience Scale Short Version (CD-RISC-10) is a 10-item scale used to assess resilience, defined as the ability to cope with stress in response to challenging experiences. The full CD-RISC consists of 25 items and has a five-factor structure, both versions displaying sound psychometric properties. Observations made during the development of the original scale indicate that resilience can be modified and improved through appropriate interventions, and greater improvement in resilience scores corresponds to more significant overall treatment outcomes. CD-RISC is one of the most frequently used tools to measure resilience. This study employed the short version, CD-RISC-10, which includes two factors labeled as Endurance and Perseverance. The CD-RISC-10 uses a 5-point Likert scale to assess resilience.

2. Neurotic Symptoms Questionnaire "O" (SQ-O)

   Time frame: Week 1 (pre-treatment); Week 4 (1 month of treatment); Week 8 (2 months of treatment); Week 12 (post-treatment; end of 3-month therapy cycle)

   The Symptoms Questionnaire "O" (SQ-O), a validated 187-item self-report tool used to measure the severity of neurotic symptoms across affective, somatic, and behavioral domains. The checklist includes 14 subscales covering different areas of neurotic psychopathology. The SQ-O can be used both diagnostically, to assess the overall severity of symptoms (cut-off scores are sex-adjusted; scores above 165 for men and 200 for women indicate symptoms exceeding the norm), as well as a measure of treatment-related change. This study focused on the overall scale scores measured at specified time points, without analyzing changes in individual subscales. Each item is scored dichotomously (0 = no, 1 = yes).

3. Psychological Insight Assessed by the Psychological Insight Questionnaire (PIQ)

   Time frame: Week 1 (pre-treatment); Week 4 (1 month of treatment); Week 8 (2 months of treatment); Week 12 (post-treatment; end of 3-month therapy cycle)

   Psychological Insight Questionnaire (PIQ) is a tool used to assess insight, defined as a series of realizations and discoveries related to personality, relationships, behavioral patterns, and emotions. The questionnaire consists of 23 items rated on a 6-point Likert scale (from 0 - none/not at all to 5 - extreme) to indicate the intensity of each experienced state over the last 7 days. The scale includes two subscales: (1) Avoidance and Maladaptive Patterns Insights and (2) Goals and Adaptive Patterns Insights, both of which demonstrate satisfactory internal consistency (Cronbach's α = 0.93 and 0.85, respectively). Although initially developed to explore the acute and lasting effects of psychedelic use, the content, sound psychometric properties, and simplicity of the PIQ encourage its use in other areas where psychological insight may be critical in predicting psychotherapy outcomes.

4. Therapeutic Alliance Level Assessed by the Working Alliance Inventory - Short Revised (WAI-SR)

   Time frame: Week 1 (pre-treatment); Week 4 (1 month of treatment); Week 8 (2 months of treatment); Week 12 (post-treatment; end of 3-month therapy cycle)

   Working Alliance Inventory - Short Revised (WAI-SR) is a 12-item revised measure assessing the quality of the therapeutic alliance as perceived by the patient. Extensive research has confirmed its effectiveness in predicting treatment outcomes. Most researchers recommend using the overall score, as the two identified subscales - Goal/Task and Bond - strongly correlate, which could interfere with accurate interpretation. The WAI-SR uses a 5-point Likert scale to assess the strength of the therapeutic alliance.

5. Freiburg Mindfulness Inventory - Short Form (FIU-14)

   Time frame: Week 1 (pre-treatment); Week 4 (1 month of treatment); Week 8 (2 months of treatment); Week 12 (post-treatment; end of 3-month therapy cycle)

   The Freiburg Mindfulness Inventory - Short Form (FIU-14) is a 14-item self-report scale designed to measure mindfulness as a general psychological trait. Mindfulness is described as a personal trait of being mindful of the moment-by-moment experience. Some of the features of mindfulness include openness, receptiveness, curiosity, and a nonjudgmental attitude. It assumes that an open and attentive individual is more in touch with feelings and experiences. Fourteen items of the questionnaire define mindfulness as a process of regulating attention. The items are rated on a 4-point Likert scale, from 1 = "rarely" to 4 = "almost always". The reliability measure of this short version is acceptable (Cronbach's alpha between 0.79 and 0.86).