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Scholten S, Schemer L, Herzog P, Haas JW, Heider J, Winter D, Reis D, Glombiewski JA. Leveraging Single-Case Experimental Designs to Promote Personalized Psychological Treatment: Step-by-Step Implementation Protocol with Stakeholder Involvement of an Outpatient Clinic for Personalized Psychotherapy. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01363-5. [PMID: 38467950 DOI: 10.1007/s10488-024-01363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
Our objective is to implement a single-case experimental design (SCED) infrastructure in combination with experience-sampling methods (ESM) into the standard diagnostic procedure of a German outpatient research and training clinic. Building on the idea of routine outcome monitoring, the SCED infrastructure introduces intensive longitudinal data collection, individual effectiveness measures, and the opportunity for systematic manipulation to push personalization efforts further. It aims to empower psychotherapists and patients to evaluate their own treatment (idiographic perspective) and to enable researchers to analyze open questions of personalized psychotherapy (nomothetic perspective). Organized around the principles of agile research, we plan to develop, implement, and evaluate the SCED infrastructure in six successive studies with continuous stakeholder involvement: In the project development phase, the business model for the SCED infrastructure is developed that describes its vision in consideration of the context (Study 1). Also, the infrastructure's prototype is specified, encompassing the SCED procedure, ESM protocol, and ESM survey (Study 2 and 3). During the optimization phase, feasibility and acceptability are tested and the infrastructure is adapted accordingly (Study 4). The evaluation phase includes a pilot implementation study to assess implementation outcomes (Study 5), followed by actual implementation using a within-institution A-B design (Study 6). The sustainability phase involves continuous monitoring and improvement. We discuss to what extent the generated data could be used to address current questions of personalized psychotherapy research. Anticipated barriers and limitations during the implementation processes are outlined.
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Affiliation(s)
- Saskia Scholten
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany.
| | - Lea Schemer
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Philipp Herzog
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
| | - Julia W Haas
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Jens Heider
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Dorina Winter
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Dorota Reis
- Applied Statistical Modeling, Universität des Saarlandes, Campus, 66123, Saarbrücken, Germany
| | - Julia Anna Glombiewski
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
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Manolov R. Does the choice of a linear trend-assessment technique matter in the context of single-case data? Behav Res Methods 2023; 55:4200-4221. [PMID: 36622560 DOI: 10.3758/s13428-022-02013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 01/10/2023]
Abstract
Trend is one of the data aspects that is an object of assessment in the context of single-case experimental designs. This assessment can be performed both visually and quantitatively. Given that trend, just like other relevant data features such as level, immediacy, or overlap does not have a single operative definition, a comparison among the existing alternatives is necessary. Previous studies have included illustrations of differences between trend-line fitting techniques using real data. In the current study, I carry out a simulation to study the degree to which different trend-line fitting techniques lead to different degrees of bias, mean square error, and statistical power for a variety of quantifications that entail trend lines. The simulation involves generating both continuous and count data, for several phase lengths, degrees of autocorrelation, and effect sizes (change in level and change in slope). The results suggest that, in general, ordinary least squares estimation performs well in terms of relative bias and mean square error. Especially, a quantification of slope change is associated with better statistical results than quantifying an average difference between conditions on the basis of a projected baseline trend. In contrast, the performance of the split-middle (bisplit) technique is less than optimal.
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Affiliation(s)
- Rumen Manolov
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Passeig de la Vall d'Hebron 171, 08035, Barcelona, Spain.
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Hollyfield S, Travers W, Sondh SK, Wilczek A, Jacobs C, McCracken LM, Scott W. An Observational Study of Outcomes Associated With Virtual Pain Management Programs Based on Acceptance and Commitment Therapy Implemented During the COVID-19 Pandemic. Clin J Pain 2023; 39:524-536. [PMID: 37449794 PMCID: PMC10498868 DOI: 10.1097/ajp.0000000000001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/18/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE In response to COVID-19, virtual, group-based interdisciplinary pain management programs (PMPs) were rapidly implemented. This included implementing different intensities and formats of virtual PMPs to address a range of patient needs and complexity. This observational study investigated outcomes associated with virtual high and low-intensity and pre-neuromodulation PMPs based on acceptance and commitment therapy as part of routine care during the pandemic. METHODS Depending on patients' needs, participants completed a virtual high-intensity or low-intensity PMP, or a virtual PMP in preparation for neuromodulation, from June 2020 to June 2022. Participants completed standardized measures of pain intensity and interference, work and social adjustment, depression, and pain acceptance before and after treatment. Data from 2018 to 2019 for in-person residential ( n= 561), outpatient ( n =123), and pre-neuromodulation ( n =207) PMPs were also examined to provide a historical benchmark of performance. RESULTS The virtual high-intensity PMP ( n =294) showed significant improvements in all variables, with small effects. There were significant improvements with small effects for pain interference, depression, and acceptance for the virtual pre-neuromodulation PMP ( n =129). No statistically significant improvements were observed for the virtual low-intensity PMP ( n =90). The improvements associated with prepandemic in-person PMPs were generally larger relative to the virtual PMPs of comparable intensity delivered during the pandemic. DISCUSSION These data provide preliminary support for the potential benefits of high, but not low, intensity virtual acceptance and commitment therapy-based PMPs, including in the context of neuromodulation. Research is needed to maximize the impact of virtual PMPs and match patients with the most appropriate delivery format.
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Affiliation(s)
| | - Warren Travers
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust
| | | | - Angelika Wilczek
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust
| | - Clair Jacobs
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust
| | | | - Whitney Scott
- INPUT Pain Management Unit, Guy’s and St Thomas’ NHS Foundation Trust
- King’s College London, Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, London, UK
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Onwumere J, Stubbs B, Stirling M, Shiers D, Gaughran F, Rice AS, C de C Williams A, Scott W. Pain management in people with severe mental illness: an agenda for progress. Pain 2022; 163:1653-1660. [PMID: 35297819 PMCID: PMC9393797 DOI: 10.1097/j.pain.0000000000002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text.
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Affiliation(s)
- Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, United Kingdom
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mary Stirling
- Involvement Register Member of South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Service User Member of Oxleas NHS Foundation Trust, London, United Kingdom
- Mind and Body Expert Advisory Group, King's Health Partners, London, United Kingdom
- Patient Governor of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
- Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Andrew S.C. Rice
- Pain Research Group, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Amanda C de C Williams
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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de la Coba P, Rodríguez-Valverde M, Hernández-López M. Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment. Internet Interv 2022; 29:100561. [PMID: 35855947 PMCID: PMC9287477 DOI: 10.1016/j.invent.2022.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/28/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Acceptance and commitment therapy (ACT) is an effective treatment for chronic pain conditions. ACT seeks to produce clinical change by enhancing Psychological Flexibility (PF). This exploratory (feasibility and preliminary effectiveness) study presents a pilot application of an online ACT group intervention for fibromyalgia (FM) with an extensive Experiential Sampling (ES) assessment of outcome and process variables via smartphone. METHOD 5-weekly ACT online group sessions were applied to 9 female FM patients. Questionnaire-based assessments of several clinical outcomes and PF processes were conducted pre- and post-intervention, and at 6-month follow-up. Extensive (6 weeks pre- and 6 weeks post-intervention) smartphone-delivered ES was implemented to gather process and outcome data in the patients' usual contexts. Clinically significant change was evaluated both at the group level and individually. RESULTS This treatment format appears to be feasible and acceptable to participants, with good adoption and completion rates (75 %) and excellent rates of treatment completion and clinical adherence (100 %). Participants showed significant reductions in affective pain, distress and biopsychosocial impact of FM both post-intervention and at 6-month follow-up (as measured with questionnaires), as well as significant improvements in satisfaction with actions and emotional discomfort (as measured through ES). Multilevel regression analyses indicated that PF-related processes assessed through ES had a significant impact on clinical outcomes and predicted the impact of FM at the 6-month follow-up. CONCLUSIONS A brief online group ACT intervention for FM was both feasible and acceptable to participants. Also, there was preliminary evidence of effectiveness in enhancing pain-related PF and producing clinical benefits in FM.
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Affiliation(s)
- Pablo de la Coba
- Corresponding author at: Departamento de Psicología, Universidad de Jaén, 23071 Jaén, Spain.
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Lavelle J, Storan D, Eswara Murthy V, De Dominicis N, Mulcahy HE, McHugh L. Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies. J Clin Med 2022; 11:2757. [PMID: 35628884 PMCID: PMC9145285 DOI: 10.3390/jcm11102757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/30/2022] [Accepted: 05/11/2022] [Indexed: 12/12/2022] Open
Abstract
Psychological intervention targeting distress is now considered an integral component of inflammatory bowel disease (IBD) management. However, significant barriers to access exist which necessitate the development of effective, economic, and accessible brief and remote interventions. Acceptance and commitment therapy (ACT) is a therapy with demonstrated acceptability and a growing evidence base for the treatment of distress in IBD populations. The present paper trialled two brief ACT interventions via randomized multiple baseline designs. Study 1 trialled a single-session ACT intervention (delivered face-to-face and lasting approximately two hours) targeting stress and experiential avoidance, respectively. Participants were seven people with an IBD diagnosis who presented with moderate to extremely severe stress (five females, two males; M age = 39.57, SD = 5.74). The findings of study 1 indicate that a single-session ACT intervention represented an insufficient dosage to reduce stress and experiential avoidance. Study 2 investigated a brief telehealth ACT intervention (delivered via a video conferencing platform and lasting approximately four hours) targeting stress and increased psychological flexibility. Participants (N = 12 people with an IBD diagnosis and mild to extremely severe stress) completed baselines lasting from 21 to 66 days before receiving a two-session ACT telehealth intervention supplemented by a workbook and phone consultation. Approximately half of participants experienced reduced stress, increased engagement in valued action, and increased functioning. Despite shortcomings such as missing data and the context of COVID-19, the present findings suggest that brief ACT interventions in this population may be effective and economic, though further research and replications are necessary.
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Affiliation(s)
- Joseph Lavelle
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (V.E.M.); (L.M.)
| | - Darragh Storan
- Department of Gastroenterology, Saint Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (D.S.); (N.D.D.); (H.E.M.)
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Varsha Eswara Murthy
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (V.E.M.); (L.M.)
| | - Noemi De Dominicis
- Department of Gastroenterology, Saint Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (D.S.); (N.D.D.); (H.E.M.)
| | - Hugh E. Mulcahy
- Department of Gastroenterology, Saint Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (D.S.); (N.D.D.); (H.E.M.)
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Louise McHugh
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (V.E.M.); (L.M.)
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Bartels SL, Johnsson SI, Boersma K, Flink I, McCracken LM, Petersson S, Christie HL, Feldman I, Simons LE, Onghena P, Vlaeyen JWS, Wicksell RK. Development, evaluation and implementation of a digital behavioural health treatment for chronic pain: study protocol of the multiphase DAHLIA project. BMJ Open 2022; 12:e059152. [PMID: 35428645 PMCID: PMC9014062 DOI: 10.1136/bmjopen-2021-059152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chronic pain affects about 20%-40% of the population and is linked to mental health outcomes and impaired daily functioning. Pharmacological interventions are commonly insufficient for producing relief and recovery of functioning. Behavioural health treatment is key to generate lasting benefits across outcome domains. However, most people with chronic pain cannot easily access evidence-based behavioural interventions. The overall aim of the DAHLIA project is to develop, evaluate and implement a widely accessible digital behavioural health treatment to improve well-being in individuals with chronic pain. METHODS AND ANALYSIS The project follows the four phases of the mHealth Agile Development and Evaluation Lifecycle: (1) development and pre-implementation surveillance using focus groups, stakeholder interviews and a business model; (2) iterative optimisation studies applying single case experimental design (SCED) method in 4-6 iterations with n=10 patients and their healthcare professionals per iteration; (3) a two-armed clinical randomised controlled trial enhanced with SCED (n=180 patients per arm) and (4) interview-based post-market surveillance. Data analyses include multilevel modelling, cost-utility and indicative analyses.In October 2021, inter-sectorial partners are engaged and funding is secured for four years. The treatment content is compiled and the first treatment prototype is in preparation. Clinical sites in three Swedish regions are informed and recruitment for phase 1 will start in autumn 2021. To facilitate long-term impact and accessibility, the treatment will be integrated into a Swedish health platform (www.1177.se), which is used on a national level as a hub for advice, information, guidance and e-services for health and healthcare. ETHICS AND DISSEMINATION The study plan has been reviewed and approved by Swedish ethical review authorities. Findings will be actively disseminated through peer-reviewed journals, conference presentations, social media and outreach activities for the wider public. TRIAL REGISTRATION NUMBER NCT05066087.
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Affiliation(s)
| | - Sophie I Johnsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Katja Boersma
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Orebro, Sweden
| | - Ida Flink
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Orebro, Sweden
| | - Lance M McCracken
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Suzanne Petersson
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Hannah L Christie
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, Netherlands
| | - Inna Feldman
- Department of Public Health and Caring Science, Uppsala Universitet, Uppsala, Sweden
| | - Laura E Simons
- Department of Anaesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Patrick Onghena
- Research Group on Methods, Individual and Cultural Differences, Affect and Social Behavior, KU Leuven, Leuven, Belgium
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
- Research Group Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Pain Clinic, Capio St. Göran Hospital, Stockholm, Sweden
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Abstract
Chronic pain conditions are common and have a considerable impact on health and wellbeing. This impact can be reduced by cognitive behavioral therapy (CBT), the most commonly applied psychological approach to chronic pain. At the same time, CBT continues to develop, and now includes what is sometimes called "third wave" CBT. In this review, we examine the evidence for application of acceptance and commitment therapy (ACT), a principal example of this new wave or latest generation of treatment approaches, in people with chronic pain. We identified 25 randomized controlled trials of ACT for adults with chronic pain. Across the included trials, small to large effect sizes favoring ACT were reported for key outcomes including pain interference, disability, depression, and quality of life. Evidence from three studies provided some support for the cost effectiveness of ACT for chronic pain. Evidence also supported the mediating role of theoretically consistent processes of change (psychological flexibility) in relation to treatment outcomes. Investigation of moderators and predictors of outcomes was limited and inconsistent. In future, a greater focus on process based treatments is recommended. This should include continued identification of evidence based processes of change, and research methods more suited to understanding the experience and needs of individual people.
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Affiliation(s)
| | - Lin Yu
- Department of Psychology, Middlesex University, London, UK
| | - Kevin E Vowles
- School of Psychology, Queens University Belfast, Belfast, UK
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Acceptance and Commitment Therapy for women living with Vulvodynia: A single-case experimental design study of a treatment delivered online. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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