Efficacy and feasibility of a transdiagnostic augmentation therapy for improving interpersonal skills using the Kiesler Circle Training (KCT)

• Applicant: Dr. Anne Guhn
• Subject Area: Personality Psychology, Clinical and Medical Psychology, Methodology ; Clinical Psychiatry, Psychotherapy, Child and Adolescent Psychiatry
• Term: since 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 457376358

Interpersonal dysfunctions constitute a risk factor for mental health. Interpersonal functioning can thus be considered a key transdiagnostic process shared by many psychiatric diagnoses. The present feasibility trial is designed to investigate a transdiagnostic group intervention for improving interpersonal functioning in patients with depression and anxiety disorders who suffer from significant interpersonal problems. The so-called Kiesler Circle Training (KCT) is rooted in the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and has been adopted for group therapy with a special focus on social interactions. KCT consists of five modules and 12 weekly sessions of 100 minutes duration. KCT significantly decreased interpersonal distress in inpatients suffering from persistent depressive disorder (PDD) who were treated with CBASP. It remains an open question whether KCT is similarly feasible and efficacious in other diagnoses than PDD, and independent of individual CBASP therapy. The present trial will investigate KCT as augmentation to state-of-the-art cognitive behavior therapy (CBT) in outpatients with a primary diagnosis of (any) depressive or (any) anxiety disorder according to DSM-5. Patients will be randomly assigned to two conditions: The experimental group (n=51) will receive individual CBT plus augmentation group therapy with KCT (CBT+KCT), while the control group (n=51) will receive individual CBT only. The power calculation is based on a phase-I-study with PDD inpatients. All patients will be assessed three times, at baseline (T1), post-intervention (T2) and at 3-months follow-up (T3). The study will allow estimating the relative difference between a conjoint CBT+KCT treatment and individual CBT. We expect KCT to improve interpersonal functioning, indicated by decreased interpersonal distress at T2 (hypothesis 1). With regard to the transdiagnostic perspective on psychiatric disorders, we further expect the improvement of interpersonal functioning to reduce depressive or anxiety symptoms. Thus, symptom reduction in the experimental group is expected to exceed the symptom reduction achieved by individual CBT (hypothesis 2). The study will provide a range of point estimates on the efficacy of KCT on standardized continuous symptom measures for primary (interpersonal functioning) and secondary endpoints (depression or anxiety symptom severity). The number and quality of daily social contacts between T1 and T2 will be investigated as mediator of change and childhood maltreatment is considered to moderate interpersonal functioning. Moreover, effective treatment components will be identified to extract the most promising treatment ingredients. These data will prospectively guide patient in- and exclusion criteria and optimize the design in preparation for conducting a larger-scale confirmatory interventional trial with an active control group.

• DFG Programme: Clinical Trials
• Co-Investigator: Professorin Dr. Eva-Lotta Brakemeier