Self-report measures as predictors of psychotherapy outcome

Premature termination from psychotherapy and internalizing psychopathology: the role of demoralization

BACKGROUND

Some research suggests that higher levels of depression and anxiety-related symptoms at intake are associated with premature termination from psychotherapy, but findings are mixed. However, theoretical and measurement considerations - introduced by a common mood factor - might complicate literature synthesis. Tellegen (1985) demonstrated that demoralization causes multicollinearity between measures of depression and anxiety, and other lines of research have converged to indicate that this construct is an important non-specific factor to consider when assessing mood pathology.

METHODS

We utilized a sample of 557 community mental health center outpatients (188 males, 265 females; 80% Caucasian) with an average age of 32.2 years (SD=10.2). We used self-report indicators to model latent low positive emotionality and negative emotionality constructs, which are temperament markers of core depressive and anxiety symptoms. We further specified a latent demoralization bifactor from these indicators.

RESULTS

As hypothesized, the bifactor model yielded significantly better fit than competing one-factor and two-factor models. Furthermore, the bifactor was substantially correlated with a demoralization measure (r=.96). As expected, low positive emotionality and negative emotionality were significant predictors of therapist ratings of premature termination. Though demoralization was a non-significant predictor, the structural paths from the other two internalizing constructs markedly increased in the bifactor model relative to the two-factor model.

LIMITATIONS

Replications with other, more diverse clinical populations using multi-method indicators of premature termination are needed.

CONCLUSIONS

This research indicates that after accounting for demoralization patients presenting with core mood disorder symptoms are at substantially increased risk for premature termination.

Psychotherapy outcome research in child psychiatric disorders

OBJECTIVE

To compile, review, and comment upon the application of psychotherapy to the treatment of psychiatric disorders first appearing in childhood and adolescence.

METHOD

Representative research papers published over the past 4 decades on the subject of psychotherapy of children and adolescents were compiled. Selection for inclusion in this review was based upon salience to the subject of treatment of child psychiatric disorders. Special consideration was given to large-scale and metaanalytic studies, as well as to studies comparing psychotherapy with other forms of treatment.

RESULTS

There is mixed evidence for the efficacy of psychotherapy for child psychiatric disorders. There are few direct comparisons between treatment modalities in the child psychiatric literature. Methodological problems include a history of theoretical development of therapies without reference to current conceptions of mental illness, a paucity of direct comparisons among psychotherapies and between psychotherapy and other psychiatric treatments, inconsistent definition of psychotherapy from study to study, and inconsistency in stated outcome measures. In general, cognitive-behavioural therapies performed better in application to child psychiatric disorders than did insight-oriented therapies.

CONCLUSIONS

Outcome research in child-oriented psychotherapy is still in its infancy. There are simply too few studies of many therapies and many conditions to draw firm conclusions about efficacy. More work is needed in matching discrete, consistently applied therapies to selected psychiatric pathologies. Questions regarding psychotherapy's potential application to prevention of mental illness and to management of distress surrounding mental illness (as distinct from treatment of the illness itself) remain to be answered.

Selected MMPI-2 scales' ability to predict premature termination and outcome from psychotherapy

Research examining the MMPI's ability to predict premature termination has yielded discrepant findings. This may be due, in part, to previous operational definitions of premature termination and extensive analysis on inadequately sized samples. This study addressed both methodological issues. This study examined MMPI-2 clinical Scales 2, 4, and 7 and content scales DEP, ASP, ANX, and TRT as predictors of premature termination and psychotherapeutic outcome in 86 adult clients seeking services at a university-based clinic. Premature termination was operationalized as therapists' ratings of clients' readiness for termination. Psychotherapeutic outcome was operationalized as therapists' ratings of the clients' progress in therapy goals, improvement in global psychopathology, improvement in current functioning, and global improvement. None of MMPI-2 scales predicted readiness for termination. However, significant associations were found between specific MMPI-2 scales and three of the four outcome ratings, with the content scales emerging as better predictors. The implications of these findings are discussed to help guide future research in this area.

Agreement between patient self-report and clinician rating: concurrence between the BSI and the GAF among psychiatric inpatients

Two rating scales were compared for 200 adult psychiatric inpatients at admission to, and discharge from, the hospital. Patients rated their own psychological symptoms on the Brief Symptom Inventory (BSI), and clinicians rated patients' psychological, social, and occupational functioning on the Global Assessment of Functioning (GAF) Scale. Analyses indicated no significant relationships between symptom distress reported by patients and global functioning rated by clinicians. These findings support previous research that has shown minimal congruence among criterion measures that differ in rating source.

The efficacy of psychoanalysis for children with disruptive disorders

OBJECTIVE

This paper describes a chart review of 763 cases of child psychoanalysis and psychotherapy at the Anna Freud Centre, and illustrates its usefulness by examining predictors of treatment outcome in children with disruptive disorders.

METHOD

135 children and adolescents with a principal diagnosis of disruptive disorder were individually matched with others suffering from emotional disorders. Outcome was indicated by diagnostic change and change in overall adaptation (clinically significant improvement or return to normal functioning).

RESULTS

Improvement rates were significantly higher for the emotional than for the disruptive group. Within the disruptive group, significant improvement was more frequent among children with oppositional defiant disorder (56%) than those with attention deficit hyperactivity disorder (36%) or conduct disorder (23%). However, 31% of the children terminated treatment within 1 year. Of those disruptive children who remained in treatment more than 1 year, 69% were no longer diagnosable on termination. Fifty-eight percent of the variance in outcome ratings could be accounted for within this group. The crucial variables in predicting attrition and symptomatic improvement were found to be quite different in the disruptive and emotional groups.

CONCLUSION

Although the study has several methodological limitations, it does suggest demographic, clinical, and diagnostic characteristics of those disruptive children most likely to benefit from intensive and nonintensive psychodynamic treatment.

Can personality traits predict psychotherapy outcome?

Ninety-six new admissions to a psychiatric outpatient clinic who attended a median of 14 therapy sessions completed a self-report Personality Profile Index prior to their first session. This index provides scores on eight dimensions of personality, a conflict measure, and a measure of social desirability. Scores were correlated with number of sessions and outcome as measured by a Symptom Checklist and by a Global Assessment Scale (GAS). Improvement was significantly related to number of sessions attended. Patients scoring high on being rejecting of others (rejection) were significantly less likely to show improvement after therapy. Rejection, aggression, passivity, and conflict were significantly related to the extent of symptoms and problems with which patients presented at the clinic.