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Phillips KE, Buinewicz SAP, Kagan E, Frank HE, Dunning E, Benito KG, Kendall PC. The Pediatric Accommodation Scale: Psychometric Evaluation of a Therapist-Report Format. Child Psychiatry Hum Dev 2024; 55:667-679. [PMID: 36149550 DOI: 10.1007/s10578-022-01447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/03/2022]
Abstract
Anxiety disorders are the most common mental health problem in youth, and accommodation is prevalent among youth with anxiety disorders. The Pediatric Accommodation Scale (PAS) is an interview administered by trained evaluators and a parent-report form (PAS-PR) to assess accommodation and its impact. Both have strong psychometric properties including internal consistency, inter-rater reliability, and data supporting construct validity. The present study evaluates the Pediatric Accommodation Scale - Therapist Report (PAS-TR), a therapist-reported version of the PAS-PR. Participants were 90 youth enrolled in cognitive behavioral therapy for anxiety. Therapists completed the PAS-TR over 16 therapy sessions. Internal consistency at baseline, convergent validity, divergent validity, and parent-therapist agreement were evaluated. Results suggest that the PAS-TR has mixed psychometric qualities suggesting that while not strong prior to the initiation of treatment, the PAS-TR may be a useful measure for therapists to rate accommodation as treatment progresses. Implications for assessment, treatment, and research are discussed.
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Affiliation(s)
- Katherine E Phillips
- Department of Psychology, Temple University, Temple University, 1701 North 13th St, 19122, Philadelphia, PA, USA.
| | | | - Elana Kagan
- Massachusetts General Hospital, Boston, MA, USA
| | - Hannah E Frank
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Erin Dunning
- Department of Psychology, Temple University, Temple University, 1701 North 13th St, 19122, Philadelphia, PA, USA
| | - Kristen G Benito
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Temple University, 1701 North 13th St, 19122, Philadelphia, PA, USA
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2
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Ciharova M, Karyotaki E, Miguel C, Walsh E, de Ponti N, Amarnath A, van Ballegooijen W, Riper H, Arroll B, Cuijpers P. Amount and frequency of psychotherapy as predictors of treatment outcome for adult depression: A meta-regression analysis. J Affect Disord 2024; 359:S0165-0327(24)00806-1. [PMID: 38777269 DOI: 10.1016/j.jad.2024.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND It is not clear whether the amount and frequency of psychotherapy is associated with treatment effects for adult depression. We investigated whether a number of indicators of the amount and frequency of psychotherapy were related to the treatment effects in randomized controlled trials (RCTs) comparing individual, face-to-face psychotherapy to a control group (e.g., care-as-usual [CAU] or waitlist condition [WL]). METHODS Four databases were systematically searched, and meta-regression analyses conducted to assess the relationship between the effect size (Hedges' g) of the treatment and number of sessions, duration of psychotherapy, total contact time with the therapist, and number of sessions per week. RESULTS We included 176 studies (210 comparisons) with 15,158 participants. We did not find a relationship between the effect size, and number of sessions, or total contact time. There was a small negative association between duration of treatment and the effect size, an additional week of treatment was related to a 0.014 decrease in the effect size. In addition, there was a strong association between number of sessions per week and the effect size, an increase from one to two sessions per week was related to an effect size higher by 0.596. Both associations were no longer significant when controlling for characteristics of studies. LIMITATIONS The current findings are correlational, future research should thus address this question in an RCT. CONCLUSIONS We should deliver brief therapies, and thus shorten waiting lists. More sessions, if necessary, should be delivered with higher frequency and over a shorter period of time.
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Affiliation(s)
- Marketa Ciharova
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Black Dog Institute, University of New South Wales, Sydney, Australia.
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; WHO Collaborating Center for Research and Dissemination of Psychological Interventions, the Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Esther Walsh
- Department of General Practice and Primary Health Care, University of Auckland, New Zealand
| | - Nino de Ponti
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Arpana Amarnath
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, New Zealand
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; WHO Collaborating Center for Research and Dissemination of Psychological Interventions, the Netherlands
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de Jong K, Douglas S, Wolpert M, Delgadillo J, Aas B, Bovendeerd B, Carlier I, Compare A, Edbrooke-Childs J, Janse P, Lutz W, Moltu C, Nordberg S, Poulsen S, Rubel JA, Schiepek G, Schilling VNLS, van Sonsbeek M, Barkham M. Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01381-3. [PMID: 38733413 DOI: 10.1007/s10488-024-01381-3] [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: 04/17/2024] [Indexed: 05/13/2024]
Abstract
We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed.
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Affiliation(s)
- Kim de Jong
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands.
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, Nashville, TN, USA
| | - Miranda Wolpert
- Division of Psychology and Language Sciences, Department of Clinical, Education and Health Psychology, University College London, United Kingdom, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Benjamin Aas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Faculty of Psychology and Educational Sciences, LMU Munich, Munich, Germany
| | - Bram Bovendeerd
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- Dimence, Center for mental health care, Deventer, The Netherlands
| | - Ingrid Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, London, UK
| | | | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Christian Moltu
- District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway
| | - Samuel Nordberg
- Department of Behavioral Health, Reliant Medical Group, Worcester, MA, USA
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Julian A Rubel
- Institute of Psychology, University of Osnabrück, Salzburg, Austria
| | - Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Ramsperger S, Witthöft M, Bräscher AK. Bridging the feedback implementation gap: A comparison of empirical and rational decision rules in naturalistic psychotherapy. Psychother Res 2024:1-15. [PMID: 38607372 DOI: 10.1080/10503307.2024.2334047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 03/14/2024] [Indexed: 04/13/2024] Open
Abstract
Objective: Previous research indicates positive effects of feedback based on rational or empirical decision rules in psychotherapy. The implementation of these usually session-to-session-based feedback systems into clinical practice, however, remains challenging. This study aims to evaluate decision rules based on routine outcome monitoring with reduced assessment frequency. Method: Data routinely collected every 5-20 sessions of N = 3758 patients treated with CBT in an outpatient clinic (Msessions = 42.8, SD = 15.4) were used to develop feedback decision rules based on the expected treatment response and nearest neighbors approach, the reliable change index, and method of percental improvement. The detection of patients at risk of treatment failure served as primary endpoint. Results: Significantly lower reliable improvement, higher reliable deterioration rates, and smaller effect sizes were found for patients identified at risk of treatment failure by all rules. The nearest neighbors-based approach showed the highest sensitivity regarding the detection of reliably deteriorated cases. Conclusion: Consistent with previous research, the empirical models outperformed the rational rules. Still, the first-time used percental improvement-based rule also showed satisfactory results. Overall, the results point to the potential of basic feedback systems that might be easier to implement in practice than session-to-session based systems.
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Affiliation(s)
- Stephan Ramsperger
- Department for Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael Witthöft
- Department for Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anne-Kathrin Bräscher
- Department for Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
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Blake J, Beazley P, Steverson T. An evaluation of an open group for depressed mood on a stroke rehabilitation ward: three years of clinical data. Disabil Rehabil 2024; 46:939-946. [PMID: 36916395 DOI: 10.1080/09638288.2023.2186498] [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] [Received: 07/29/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE An open group intervention for stroke inpatients, based on Acceptance and Commitment Therapy, is evaluated using retrospective clinical service data. MATERIALS AND METHODS Participants were included unless severely unwell or unable to provide informed consent. 117 participants attended at least two sessions in a non-controlled, repeated measures design. Two session protocols were delivered on alternating weeks by an Assistant Psychologist and Trainee Psychologist, covering values, committed action, and acceptance. Participants rated their mood each session using the Depression Intensity Scale Circles (DISCs). RESULTS Attended sessions ranged from 1 to 11 (Md: 2). Significant reductions in DISCs scores with medium effect sizes were found among those scoring above the cut-off for depression at baseline, Χ2(3) = 20.87, p < .001. The likelihood of scoring below the cut-off for depression did not change between participants' first and last sessions, X2(1, N = 117) = 1.36, p = .24. The number of sessions attended did not predict outcome, rs(117) = .09, p = .33. CONCLUSIONS Design limitations prevented inferences of clinical effectiveness, but the group met several clinical utility criteria by providing a flexible intervention on a rehabilitation ward with competing demands. We highlight the importance of contrasting findings of clinical trials with data from clinical services.
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Affiliation(s)
- Joshua Blake
- Clinical Psychology, University of East Anglia, Norwich, UK
| | - Peter Beazley
- Deputy Course Director, Doctorate in Clinical Psychology, University of East Anglia, Norwich, UK
| | - Tom Steverson
- Clinical Psychologist, Norfolk Community Health and Care NHS Trust and University of East Anglia, Norwich, UK
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McGregor G, Sandhu H, Bruce J, Sheehan B, McWilliams D, Yeung J, Jones C, Lara B, Alleyne S, Smith J, Lall R, Ji C, Ratna M, Ennis S, Heine P, Patel S, Abraham C, Mason J, Nwankwo H, Nichols V, Seers K, Underwood M. Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial. BMJ 2024; 384:e076506. [PMID: 38325873 PMCID: PMC11134408 DOI: 10.1136/bmj-2023-076506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To evaluate whether a structured online supervised group physical and mental health rehabilitation programme can improve health related quality of life compared with usual care in adults with post-covid-19 condition (long covid). DESIGN Pragmatic, multicentre, parallel group, superiority randomised controlled trial. SETTING England and Wales, with home based interventions delivered remotely online from a single trial hub. PARTICIPANTS 585 adults (26-86 years) discharged from NHS hospitals at least three months previously after covid-19 and with ongoing physical and/or mental health sequelae (post-covid-19 condition), randomised (1:1.03) to receive the Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) intervention (n=298) or usual care (n=287). INTERVENTIONS Best practice usual care was a single online session of advice and support with a trained practitioner. The REGAIN intervention was delivered online over eight weeks and consisted of weekly home based, live, supervised, group exercise and psychological support sessions. MAIN OUTCOME MEASURES The primary outcome was health related quality of life using the patient reported outcomes measurement information system (PROMIS) preference (PROPr) score at three months. Secondary outcomes, measured at three, six, and 12 months, included PROMIS subscores (depression, fatigue, sleep disturbance, pain interference, physical function, social roles/activities, and cognitive function), severity of post-traumatic stress disorder, general health, and adverse events. RESULTS Between January 2021 and July 2022, 39 697 people were invited to take part in the study and 725 were contacted and eligible. 585 participants were randomised. Mean age was 56 (standard deviation (SD) 12) years, 52% were female participants, mean health related quality of life PROMIS-PROPr score was 0.20 (SD 0.17), and mean time from hospital discharge was 323 (SD 144) days. Compared with usual care, the REGAIN intervention led to improvements in health related quality of life (adjusted mean difference in PROPr score 0.03 (95% confidence interval 0.01 to 0.05), P=0.02) at three months, driven predominantly by greater improvements in the PROMIS subscores for depression (1.39 (0.06 to 2.71), P=0.04), fatigue (2.50 (1.19 to 3.81), P<0.001), and pain interference (1.80 (0.50 to 3.11), P=0.01). Effects were sustained at 12 months (0.03 (0.01 to 0.06), P=0.02). Of 21 serious adverse events, only one was possibly related to the REGAIN intervention. In the intervention group, 141 (47%) participants fully adhered to the programme, 117 (39%) partially adhered, and 40 (13%) did not receive the intervention. CONCLUSIONS In adults with post-covid-19 condition, an online, home based, supervised, group physical and mental health rehabilitation programme was clinically effective at improving health related quality of life at three and 12 months compared with usual care. TRIAL REGISTRATION ISRCTN registry ISRCTN11466448.
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Affiliation(s)
- Gordon McGregor
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Research Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Harbinder Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Julie Bruce
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - David McWilliams
- Centre for Care Excellence, University Hospitals Coventry and Warwickshire NHS Trust and Coventry University, Coventry, UK
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Anaesthesia and Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Beatriz Lara
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Sharisse Alleyne
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jessica Smith
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Mariam Ratna
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stuart Ennis
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Heine
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Shilpa Patel
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - James Mason
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Henry Nwankwo
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Vivien Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Helmich MA. The Duration-Adjusted Reliable Change Index: Defining Clinically Relevant Symptom Changes of Varying Durations. Assessment 2024:10731911231221808. [PMID: 38279795 DOI: 10.1177/10731911231221808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
The time period over which relevant symptoms shifts unfold is not uniform across individuals. This article proposes an adaptation of the Reliable Change Index (RCI) to detect symptom changes of varying durations in individual patients' time series: the Duration-Adjusted RCI (DARCI). The DARCI proportionally raises the RCI cut-off to account for its extension over additional time increments, resulting in different DARCI thresholds for different change durations. The method is illustrated with a simulation study of depressive symptom time series with varying degrees of discontinuity and overall mean change, and four empirical case examples from two clinical samples. The results suggest that the DARCI may be particularly useful for identifying symptom shifts that appear relatively abrupt, which can help indicate when a patient is showing significant improvement or deterioration. Its ease of use makes it suitable for application in clinical contexts and a promising method for exploring transitions in psychiatric populations.
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Affiliation(s)
- Marieke A Helmich
- Department of Psychology, University of Oslo, Oslo, Norway
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
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McDaniel BT, Cornet V, Carroll J, Chrones L, Chudzik J, Cochran J, Guha S, Lawrence DF, McCue M, Sarkey S, Lorenz B, Fawver J. Real-world clinical outcomes and treatment patterns in patients with MDD treated with vortioxetine: a retrospective study. BMC Psychiatry 2023; 23:938. [PMID: 38093196 PMCID: PMC10720213 DOI: 10.1186/s12888-023-05439-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND This study included evaluation of the effectiveness of vortioxetine, a treatment for adults with major depressive disorder (MDD), using patient-reported outcome measures (PROMs) in a real-world setting. METHODS This retrospective chart review analyzed the care experiences of adult patients with a diagnosis of MDD from Parkview Physicians Group - Mind-Body Medicine, Midwestern United States. Patients with a prescription for vortioxetine, an initial baseline visit, and ≥ 2 follow-up visits within 16 weeks from September 2014 to December 2018 were included. The primary outcome measure was effectiveness of vortioxetine on depression severity as assessed by change in Patient Health Questionnaire-9 (PHQ-9) scores ~ 12 weeks after initiation of vortioxetine. Secondary outcomes included changes in depression-related symptoms (i.e., sexual dysfunction, sleep disturbance, cognitive function, work/social function), clinical characteristics, response, remission, and medication persistence. Clinical narrative notes were also analyzed to examine sleep disturbance, sexual dysfunction, appetite, absenteeism, and presenteeism. All outcomes were examined at index (start of vortioxetine) and at ~ 12 weeks, and mean differences were analyzed using pairwise t tests. RESULTS A total of 1242 patients with MDD met inclusion criteria, and 63.9% of these patients had ≥ 3 psychiatric diagnoses and 65.9% were taking ≥ 3 medications. PHQ-9 mean scores decreased significantly from baseline to week 12 (14.15 ± 5.8 to 9.62 ± 6.03, respectively; p < 0.001). At week 12, the response and remission rates in all patients were 31.0% and 23.1%, respectively, and 67% continued vortioxetine treatment. Overall, results also showed significant improvements by week 12 in anxiety (p < 0.001), sexual dysfunction (p < 0.01), sleep disturbance (p < 0.01), cognitive function (p < 0.001), work/social functioning (p = 0.021), and appetite (p < 0.001). A significant decrease in presenteeism was observed at week 12 (p < 0.001); however, no significant change was observed in absenteeism (p = 0.466). CONCLUSIONS Using PROMs, our study results suggest that adults with MDD prescribed vortioxetine showed improvement in depressive symptoms in the context of a real-world clinical practice setting. These patients had multiple comorbid psychiatric and physical diagnoses and multiple previous antidepressant treatments had failed.
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Affiliation(s)
- Brandon T McDaniel
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | - Victor Cornet
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | - Jeanne Carroll
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | | | - Joseph Chudzik
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | - Jeanette Cochran
- Parkview Physicians Group - Mind-Body Medicine, Fort Wayne, IN, US
| | - Shion Guha
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
- Faculty of Information, Department of Computer Science, University of Toronto, Toronto, ON, Canada
| | | | - Maggie McCue
- Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA, US
| | - Sara Sarkey
- Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA, US
| | - Betty Lorenz
- Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA, US
| | - Jay Fawver
- Parkview Physicians Group - Mind-Body Medicine, Fort Wayne, IN, US.
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9
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Gliske K, Ballard J, Berry KR, Killian M, Kroll E, Fenkel C. Reduction of Mental Health-Related Emergency Department Admissions for Youth and Young Adults Following a Remote Intensive Outpatient Program: Quality Improvement Analysis. JMIR Form Res 2023; 7:e47895. [PMID: 37943600 PMCID: PMC10667974 DOI: 10.2196/47895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Pediatric mental health emergency department (ED) visits are increasing at 6% to 10% per year, at substantial cost, while 13% of youth with psychiatric hospitalizations are readmitted in the following weeks. Hospitals do not have the resources to meet escalating youth's mental health needs. Intensive outpatient (IOP) programs, which provide multiple hours of care each week, have the power to reduce the number of patients in need of hospitalized care and provide a step-down option for patients discharging from ED's in order to prevent readmissions. OBJECTIVE The purpose of this program evaluation was to assess (1) whether youth and young adult ED admission rates decreased following participation in a remote IOP program and (2) whether there were differences in readmission rates between youth and young adults by gender identity, sexual orientation, race, or ethnicity. METHODS Data were collected from intake and 3-month postdischarge surveys for 735 clients who attended at least 6 sessions of a remote IOP program for youth and young adults. Patients reported if they had been admitted to an ED within the previous 30 days and the admission reason. Over half (407/707, 57.6%) of clients were adolescents and the rest were young adults (300/707, 42.4%; mean age 18.25, SD 4.94 years). The sample was diverse in gender identity (329/687, 47.9% female; 196/687, 28.5% male; and 65/669, 9.7% nonbinary) and sexual orientation (248/635, 39.1% heterosexual; 137/635, 21.6% bisexual; 80/635, 10.9% pansexual; and 170/635, 26.8% other sexual orientation) and represented several racial (9/481, 1.9% Asian; 48/481, 10% Black; 9/481, 1.9% Indigenous; 380/481, 79% White; and 35/481, 7.2% other) and ethnic identities (112/455, 24.6% Hispanic and 28/455, 6.2% other ethnic identity). RESULTS Mental health-related ED admissions significantly decreased between intake and 3 months after discharge, such that 94% (65/69) of clients with a recent history of mental health-related ED admissions at IOP intake reported no mental health-related ED admissions at 3 months after discharge from treatment (χ21=38.8, P<.001). There were no differences in ED admissions at intake or in improvement at 3 months after discharge by age, gender, sexuality, race, or ethnicity. CONCLUSIONS This study documents a decrease in ED admissions between intake and 3 months after discharge among both youth and young adults who engage in IOP care following ED visits. The similar outcomes across demographic groups indicate that youth and young adults experience similar decreases after the current tracks of programming. Future research could conduct a full return-on-investment analysis for intensive mental health services for youth and young adults.
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Affiliation(s)
- Kate Gliske
- Charlie Health Inc, Bozeman, MT, United States
| | - Jaime Ballard
- Center For Applied Research and Educational Improvement, University of Minnesota, Saint Paul, MN, United States
| | | | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, United States
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10
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Abstract
Recent work has highlighted that process-outcome relationships are likely to vary depending on the client, yet much work remains to be done in the area of tailoring interventions to a given client. This naturalistic single-case analysis provides an example of augmenting a treatment protocol with "off protocol" relaxation methods, based on routinely collected outcome information to guide shared decision making. Intensive case study analyses were applied to one client with principal generalized anxiety disorder and comorbid major depressive disorder receiving transdiagnostic cognitive-behavioral therapy. The client completed two routine anxiety and depression symptom and functioning scales prior to each session of naturalistic treatment. Time series analyses were applied to the two symptom measures. Among the results, (a) significant linear decreases in anxiety and depression from baseline to posttreatment were observed; and (b) the introduction of relaxation methods had a significant impact on the course of anxiety symptom change. In conclusion, routine outcome assessment can be used to inform intervention augmentation with individual clients. Furthermore, regular assessment is needed to determine if a client may benefit from an alternative set of specific intervention strategies.
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11
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Larionov K, Petrova E, Demirbuga N, Werth O, Breitner MH, Gebhardt P, Caldarone F, Duncker D, Westhoff-Bleck M, Sensenhauser A, Maxrath N, Marschollek M, Kahl KG, Heitland I. Improving mental well-being in psychocardiology-a feasibility trial for a non-blended web application as a brief metacognitive-based intervention in cardiovascular disease patients. Front Psychiatry 2023; 14:1138475. [PMID: 37840797 PMCID: PMC10568139 DOI: 10.3389/fpsyt.2023.1138475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/28/2023] [Indexed: 10/17/2023] Open
Abstract
Background Many patients with cardiovascular disease also show a high comorbidity of mental disorders, especially such as anxiety and depression. This is, in turn, associated with a decrease in the quality of life. Psychocardiological treatment options are currently limited. Hence, there is a need for novel and accessible psychological help. Recently, we demonstrated that a brief face-to-face metacognitive therapy (MCT) based intervention is promising in treating anxiety and depression. Here, we aim to translate the face-to-face approach into digital application and explore the feasibility of this approach. Methods We translated a validated brief psychocardiological intervention into a novel non-blended web app. The data of 18 patients suffering from various cardiac conditions but without diagnosed mental illness were analyzed after using the web app over a two-week period in a feasibility trial. The aim was whether a non-blended web app based MCT approach is feasible in the group of cardiovascular patients with cardiovascular disease. Results Overall, patients were able to use the web app and rated it as satisfactory and beneficial. In addition, there was first indication that using the app improved the cardiac patients' subjectively perceived health and reduced their anxiety. Therefore, the approach seems feasible for a future randomized controlled trial. Conclusion Applying a metacognitive-based brief intervention via a non-blended web app seems to show good acceptance and feasibility in a small target group of patients with CVD. Future studies should further develop, improve and validate digital psychotherapy approaches, especially in patient groups with a lack of access to standard psychotherapeutic care.
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Affiliation(s)
- Katharina Larionov
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ekaterina Petrova
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Nurefsan Demirbuga
- Information Systems Institute, Leibniz University Hannover, Hannover, Germany
| | - Oliver Werth
- OFFIS - Institute for Information Technology, Oldenburg, Germany
| | - Michael H. Breitner
- Information Systems Institute, Leibniz University Hannover, Hannover, Germany
| | - Philippa Gebhardt
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Flora Caldarone
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Anja Sensenhauser
- University of Applied Sciences and Arts, Hochschule Hannover, Hannover, Germany
| | - Nadine Maxrath
- TU Braunschweig and Hannover Medical School, Peter L. Reichertz Institute for Medical Informatics, Hannover, Germany
| | - Michael Marschollek
- TU Braunschweig and Hannover Medical School, Peter L. Reichertz Institute for Medical Informatics, Hannover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Halverson TF, Calhoun PS, Elbogen EB, Andover MS, Beckham JC, Pugh MJ, Kimbrel NA. Nonsuicidal self-injury among veterans is associated with psychosocial impairment, suicidal thoughts and behaviors, and underutilization of mental health services. DEATH STUDIES 2023; 48:238-249. [PMID: 37235533 PMCID: PMC10676439 DOI: 10.1080/07481187.2023.2216169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a robust predictor of suicide attempts. However, understanding of NSSI and associated treatment utilization among Veterans is limited. Although impairment may be assumed, few studies examine the association between NSSI and psychosocial functioning, a core component of the rehabilitation framework of mental health. In a national survey of Veterans, current NSSI (n = 88) was associated with higher rates of suicidal thoughts and behaviors and more severe psychosocial impairment after adjusting for demographics and probable diagnoses of posttraumatic stress disorder, major depressive disorder, and alcohol use disorder, compared to Veterans without NSSI (n = 979). Only half of Veterans with NSSI were engaged with mental health services, with few appointments attended, suggesting that these Veterans are not receiving treatment interventions. Results underscore the adverse outcomes associated with NSSI. Underutilization of mental health services highlights the importance of screening for NSSI among Veterans to improve psychosocial outcomes.
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Affiliation(s)
- Tate F Halverson
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Eric B Elbogen
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA National Center on Homelessness Among Veterans, Tampa, Florida, USA
| | | | - Jean C Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Mary Jo Pugh
- VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
- Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
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13
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Ewen ACI, Bleichhardt G, Rief W, Von Blanckenburg P, Wambach K, Wilhelm M. Expectation focused and frequency enhanced cognitive behavioural therapy for patients with major depression (EFFECT): a study protocol of a randomised active-control trial. BMJ Open 2023; 13:e065946. [PMID: 36948546 PMCID: PMC10040046 DOI: 10.1136/bmjopen-2022-065946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION The effectiveness of psychotherapy in depression is subject of an ongoing debate. The mechanisms of change are still underexplored. Research tries to find influencing factors fostering the effect of psychotherapy. In that context, the dose-response relationship should receive more attention. Increasing the frequency from one to two sessions per week seems to be a promising start. Moreover, the concept of expectations and its influence in depression can be another auspicious approach. Dysfunctional expectations and the lack of their modification are central in symptom maintenance. Expectation focused psychological interventions (EFPI) have been investigated, primarily in the field of depression. The aim of this study is to compare cognitive behavioural therapy (CBT) once a week with an intensified version of CBT (two times a week) in depression as well as to include a third proof-of-principle intervention group receiving a condensed expectation focused CBT. METHODS AND ANALYSIS Participants are recruited through an outpatient clinic in Germany. A current major depressive episode, diagnosed via structured clinical interviews should present as the main diagnosis. The planned randomised-controlled trial will allow comparisons between the following treatment conditions: CBT (one session/week), condensed CBT (two sessions/week) and EFPI (two sessions/week). All treatment arms include a total dose of 24 sessions. Depression severity applies as the outcome variable (Beck Depression Inventory II, Montgomery Asberg Depression Rating Scale). A sample size of n=150 is intended. ETHICS AND DISSEMINATION The local ethics committee of the Department of Psychology, Philipps-University Marburg approved the study (reference number 2020-68 v). The final research article including the study results is intended to be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER German Clinical Trials Registry (DRKS00023203).
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Affiliation(s)
- Anne-Catherine Isabelle Ewen
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Marburg, Germany
| | - Gaby Bleichhardt
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Marburg, Germany
| | - Winfried Rief
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Marburg, Germany
| | - Pia Von Blanckenburg
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Marburg, Germany
| | - Katrin Wambach
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Marburg, Germany
| | - Marcel Wilhelm
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Marburg, Germany
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14
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Lee S, Arora IS. The effectiveness, acceptability, and sustainability of a 4-week DBT-informed group therapy in increasing psychological resilience for college students with mental health issues. J Clin Psychol 2023. [PMID: 36920177 DOI: 10.1002/jclp.23509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 01/08/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE An adapted, time-limited dialectical behavior therapy (DBT) skills training group therapy can prove to be an evidence-based treatment that can easily fit the needs, demands, and limitations of University Counseling Centers to serve college students with mental disorders. The present naturalistic study investigated the effectiveness, acceptability, and sustainability of a 4-week DBT-informed group therapy in enhancing psychological resilience. METHODS Participants included 59 college students with heterogeneous mental health concerns. They attended weekly 1.5-hr DBT-informed, resilience-building group therapy for 4 weeks. Psychological resilience, mindfulness, emotional dysregulation, and overall distress were assessed at pretreatment and posttreatment, as well as at 1- and 3-month follow-ups. RESULTS Findings showed increased psychological resilience among the participants at posttreatment and follow-ups, and provided preliminary evidence for the role of mindfulness as an important contributor to enhancing psychological resilience even after controlling for risk factors, treatment dosage, pregroup psychological resilience, and changes in emotion dysregulation and overall distress. CONCLUSION A 4-week DBT-informed skills training group therapy can be utilized as a time-efficient, cost-effective, well-accepted preventative treatment with the potential longitudinal impact to boost psychological resilience for college students with mental health issues.
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Affiliation(s)
- Soonhee Lee
- Counseling Center, University of Maryland, Baltimore County (UMBC), Baltimore, Maryland, USA
| | - Ishita Sunita Arora
- Department of Human Services Psychology, University of Maryland, Baltimore County (UMBC), Baltimore, Maryland, USA
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15
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Lin T, Anderson T, Austin M, Mischkowski D. Early trajectories of symptom change and working alliance as predictors of treatment outcome. Psychother Res 2023; 33:185-197. [PMID: 35659497 DOI: 10.1080/10503307.2022.2080028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE We aim to examine how different trajectories of symptom change and working alliance in early psychotherapy predict treatment outcomes. METHOD We performed a growth mixture model (GMM) to examine trajectories of symptom change and working alliance in the first five therapy sessions in a sample of 272 outpatients and tested the association of early symptom trajectories and alliance patterns with treatment outcome. RESULTS We identified two symptom trajectories: high symptom/steady change (63.2%) and early improving (36.8%), and four alliance development patterns: undeveloped alliance (40.1%), strengthening moderate alliance (31.6%), optimal alliance (17.3%), and improved alliance (11%) in early psychotherapy. The symptom trajectories and alliance patterns both independently and interactively predicted treatment outcomes. The optimal alliance was generally associated with the best outcome. The effect of improved alliance on treatment outcome was moderated by symptom trajectories: for high symptom/steady change subgroup, the improved alliance was related to better treatment outcome, whereas for early improving subgroup, the improved alliance was associated with poorer outcome. CONCLUSIONS Patients fell into different trajectories regarding symptom reduction and alliance development in early psychotherapy that affected final treatment outcome. Combining early symptom trajectories and alliance trajectories simultaneously can facilitate routine outcome monitoring and contribute to the prediction of treatment outcome.
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Affiliation(s)
- Tao Lin
- Department of Psychology, Ohio University, Athens, OH, USA
| | | | - Megan Austin
- Department of Psychology, Ohio University, Athens, OH, USA
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16
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Berry KR, Gliske K, Schmidt C, Cray LDE, Killian M, Fenkel C. LGBTQIA+ Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment (Preprint). JMIR Form Res 2023; 7:e45796. [PMID: 37083637 PMCID: PMC10163404 DOI: 10.2196/45796] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers because of stigmatization, which may prevent continuation of care, yet there is a lack of mental health treatment and outcome research addressing these disparities. However, there is some indication that LGBTQIA+ individuals feel more comfortable with web-based formats, indicating that telehealth services may be beneficial for this population. OBJECTIVE This program evaluation explored the effectiveness of a remote intensive outpatient program with a curriculum tailored specifically to LGBTQIA+ youth with high-acuity depression, anxiety, and suicidality. This study sought to understand baseline acuity differences between LGBTQIA+ and non-LGBTQIA+ youth and young adult patients and to determine if there were differences in clinically significant improvement by subtypes within the LGBTQIA+ population following participation in LGBTQIA+-specific programming. METHODS Data were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-injury (NSSI) in 878 patients who attended at least six sessions of a remote intensive outpatient program for youth and young adults. Of these 878 clients, 551 (62.8%) were identified as having at least one LGBTQIA+ identity; they participated in an LGBTQIA+-adapted program of the general curriculum. RESULTS LGBTQIA+ patients had more clinically severe intake for depression, NSSI, and suicidal ideation. Nonbinary clients had greater NSSI within the LGBTQIA+ sample at intake than their binary counterparts, and transgender clients had significantly higher depressive scores at intake than their nontransgender counterparts. LGBTQIA+ patients demonstrated improvements in all outcomes from intake to discharge. The Patient Health Questionnaire for Adolescents depression scores improved from 18.15 at intake to 10.83 at discharge, representing a 41.5% reduction in depressive symptoms. Overall, 50.5% (149/295) of the LGBTQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge, 72.1% (160/222) who endorsed active suicidal ideation at intake no longer reported it at discharge, and 55.1% (109/198) of patients who met the criteria for clinical NSSI no longer met the criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical NSSI at discharge. CONCLUSIONS This program evaluation found substantial differences in rates of depression, NSSI, and suicidal ideation between LGBTQIA+ clients compared with their non-LGBTQIA+ counterparts. In addition, this evaluation showed a considerable decrease in symptoms when clients attended LGBTQIA+-affirming care. The findings provide support for the role of LGBTQIA+-specific programming to meet the elevated mental health needs of these youth and that more research is needed to understand barriers that may negatively affect transgender clients, specifically.
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Affiliation(s)
| | - Kate Gliske
- Charlie Health, Inc, Bozeman, MT, United States
| | | | | | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, United States
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17
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Koszycki D, Taljaard M, Kogan C, Bradwejn J, Grimes D. Interpersonal Psychotherapy for Depression in Parkinson's Disease: A Feasibility Study. J Geriatr Psychiatry Neurol 2023; 36:52-62. [PMID: 35446178 PMCID: PMC9755694 DOI: 10.1177/08919887221090220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Individuals living with Parkinson's disease (PD) experience interpersonal stressors that contribute to depressive risk. Interpersonal psychotherapy (IPT) emphasizes the bidirectional relationship between interpersonal stressors and mood may therefore be a suitable treatment for PD-depression. The primary aim of this study was to evaluate the feasibility of delivering 12 sessions of IPT to depressed PD patients and explore the need for modifications. A secondary aim was to obtain descriptive information about efficacy outcomes. The study used a pre-post design without a comparison group. Participants were 12 PD patients with a major depressive disorder. IPT was well accepted and tolerated by patients and required minimal modifications. Compliance with session attendance and completion of study questionnaires were excellent and treatment satisfaction was high. Depression scores declined from baseline to endpoint, with 7 patients meeting criteria for remission at endpoint. Findings are encouraging and a larger randomized controlled trial is currently underway to ascertain if IPT is an efficacious treatment for PD-depression.
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Affiliation(s)
- Diana Koszycki
- University of Ottawa, Ottawa, ON, Canada,Institut du savoir Montfort, Montfort Hospital, Ottawa, ON, Canada,University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada,Diana Koszycki, PhD, University of Ottawa, 145 Jean-Jacques Lussier Ottawa, ON K1N 6N5, Canada.
| | - Monica Taljaard
- University of Ottawa, Ottawa, ON, Canada,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Cary Kogan
- University of Ottawa, Ottawa, ON, Canada
| | - Jacques Bradwejn
- University of Ottawa, Ottawa, ON, Canada,Institut du savoir Montfort, Montfort Hospital, Ottawa, ON, Canada,Université de Montreal, QC, Canada
| | - David Grimes
- University of Ottawa, Ottawa, ON, Canada,University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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18
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Mahon D. A scoping review of deliberate practice in the acquisition of therapeutic skills and practices. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Schuringa E, Spreen M, Bogaerts S. Treatment Evaluation in Forensic Psychiatry. Which One Should Be Used: The Clinical Judgment or the Instrument-based Assessment of Change? INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022; 66:1821-1836. [PMID: 34114499 DOI: 10.1177/0306624x211023921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In forensic psychiatry, it is common practice to use an unstructured clinical judgment for treatment evaluation. From risk assessment studies, it is known that the unstructured clinical judgment is unreliable and the use of instruments is recommended. This paper aims to explore the clinical judgment of change compared to the calculated change using the Instrument for Forensic Treatment Evaluation (IFTE) in relation to changes in inpatient violence This study shows that the clinical judgment is much more positive about patient's behavioral changes than the calculated change. And that the calculated change is more in accordance with the change in the occurrence of inpatient violence, suggesting that the calculated change reflects reality closer than the unstructured clinical judgment. Therefore, it is advisable to use the IFTE as a base to make a structured professional judgment of the treatment evaluation of a forensic psychiatric patient.
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Affiliation(s)
| | - Marinus Spreen
- NHLStenden University of Applied Sciences, Leeuwarden, The Netherlands
| | - Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, The Netherlands
- Fivoor Research & Treatment Innovation, Poortugaal, The Netherlands
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20
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de la Parra G, Zuñiga AK, Crempien C, Morales S, Errázuriz A, Martínez P, Aravena C, Ferrari T. Delphi-validation of a Psychotherapeutic Competencies Training Protocol (PCTP) for the treatment of depression in primary care: evidence-based practice and practice-based evidence ( Validación Delphi de un Protocolo de Entrenamiento en Competencias Psicoterapéuticas (PECP) para el tratamiento de la depresión en atención primaria: práctica basada en la evidencia y evidencia basada en la práctica). STUDIES IN PSYCHOLOGY 2022. [DOI: 10.1080/02109395.2022.2127239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Guillermo de la Parra
- Pontificia Universidad Católica de Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad – MIDAPS
| | | | - Carla Crempien
- Pontificia Universidad Católica de Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad – MIDAPS
| | - Susana Morales
- Pontificia Universidad Católica de Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad – MIDAPS
| | - Antonia Errázuriz
- Pontificia Universidad Católica de Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad – MIDAPS
| | - Pablo Martínez
- Instituto Milenio para la Investigación en Depresión y Personalidad – MIDAPS
- Universite de Sherbrooke
| | - Catalina Aravena
- Instituto Milenio para la Investigación en Depresión y Personalidad – MIDAPS
- Universidad de Chile
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Weinzimmer SA, Goetz AR, Guzick AG, Hana LM, Cepeda SL, Schneider SC, Kennedy SM, Amos Nwankwo GN, Christian CC, Shaw AM, Salloum A, Shah AA, Goodman WK, Ehrenreich-May J, Storch EA. Primary Outcomes for Adults Receiving the Unified Protocol after Hurricane Harvey in an Integrated Healthcare Setting. Community Ment Health J 2022; 58:1522-1534. [PMID: 35377090 PMCID: PMC9962349 DOI: 10.1007/s10597-022-00967-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/16/2022] [Indexed: 01/27/2023]
Abstract
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) has demonstrated efficacy for treating anxiety and depression. However, there are limited effectiveness data when conducted in real-world settings with diverse populations, including those with trauma. We evaluated treatment outcomes in a naturalistic, community setting among 279 adults who received UP following Hurricane Harvey. We examined change in overall clinical severity, depression and anxiety symptoms, functional impairment, and baseline outcome predictors (i.e., demographic characteristics, impact from Hurricane Harvey, co-occurrence of depression and anxiety symptoms). Global clinical severity, depression and anxiety symptoms, and functional impairment decreased by end-of-treatment. Participants experienced global symptom improvement to a lesser degree than demonstrated in efficacy trials. Participants who experienced greater storm impact reported larger reductions in anxiety symptoms than those less impacted by Harvey. Further studies evaluating the effectiveness of the UP post-disaster and with diverse samples are needed.
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Affiliation(s)
- Saira A Weinzimmer
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX, 77030, USA
| | - Amy R Goetz
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX, 77030, USA
| | - Andrew G Guzick
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX, 77030, USA
| | - Lynn M Hana
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX, 77030, USA
| | - Sandra L Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX, 77030, USA
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX, 77030, USA
| | - Sarah M Kennedy
- School of Medicine, University of Colorado, 1635 Aurora Ct, Aurora, CO, 80045, USA
| | - Gifty N Amos Nwankwo
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX, 77030, USA
| | - Catherine C Christian
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX, 77030, USA
| | - Ashley M Shaw
- Center for Children and Families, Florida International University, 11200 Southwest 8th Street, AHC1 140, Miami, FL, 33199, USA
| | - Alison Salloum
- College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Asim A Shah
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX, 77030, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX, 77030, USA
| | - Jill Ehrenreich-May
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite E4.400, Houston, TX, 77030, USA.
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22
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Probst T, Humer E, Jesser A, Pieh C. Attitudes of psychotherapists towards their own performance and the role of the social comparison group: The self-assessment bias in psychodynamic, humanistic, systemic, and behavioral therapists. Front Psychol 2022; 13:966947. [DOI: 10.3389/fpsyg.2022.966947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Studies report that psychotherapists overestimate their own performance (self-assessment bias). This study aimed to examine if the self-assessment bias in psychotherapists differs between therapeutic orientations and/or between social comparison groups. Psychotherapists gave subjective estimations of their professional performance (0–100 scale from poorest to best performance) compared to two social comparison groups (“all psychotherapists” vs. “psychotherapists with the same therapeutic approach”). They further rated the proportion of their patients recovering, improving, not changing, or deteriorating. In total, N = 229 Austrian psychotherapists (n = 39 psychodynamic, n = 121 humanistic, n = 48 systemic, n = 21 behavioral) participated in the online survey. Psychotherapists rated their own performance on average at M = 79.11 relative to “all psychotherapists” vs. at M = 77.76 relative to “psychotherapists with the same therapeutic approach” (p < 0.05). This was not significantly different between therapeutic orientations. A significant interaction between social comparison group and therapeutic orientation (p < 0.05) revealed a drop of self-assessement bias in social comparison group “same approach” vs. “all psychotherapists” in psychodynamic and humanistic therapists (p < 0.05). Psychotherapists overestimated the proportion of patients recovering (M = 44.76%), improving (M = 43.73%) and underestimated the proportion of patients not changing (M = 9.86%) and deteriorating (M = 1.64%), with no differences between orientations. The self-assessment bias did not differ between therapeutic orientations, but the social comparison group appears to be an important variable. A major drawback is that results have not been connected to patient-reported outcome or objectively rated performance parameters.
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Dogmanas D, Arias MA, Gago F, de Álava L, Roussos A. Implementation of a psychological treatment outcomes evaluation system for young people at Uruguay's National Health System: Using
CORE‐OM. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Denisse Dogmanas
- Facultad de Psicología Universidad de la República Montevideo Uruguay
| | | | - Fiorella Gago
- Facultad de Psicología Universidad de la República Montevideo Uruguay
| | - Laura de Álava
- Facultad de Psicología Universidad de la República Montevideo Uruguay
| | - Andres Roussos
- CONICET, Universidad de Buenos Aires Buenos Aires Argentina
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Dammen T, Tunheim K, Munkhaugen J, Papageorgiou C. The Attention Training Technique Reduces Anxiety and Depression in Patients With Coronary Heart Disease: A Pilot Feasibility Study. Front Psychol 2022; 13:948081. [PMID: 35967654 PMCID: PMC9363691 DOI: 10.3389/fpsyg.2022.948081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives Depression and anxiety symptoms are highly prevalent in coronary heart disease (CHD) patients and associated with poor outcome. Most psychological treatments have shown limited effectiveness on anxiety and depression in these patients. This study evaluates the feasibility of the attention training technique (ATT) in CHD patients with symptoms of anxiety and/or depression. Methods Five consecutive CHD patients with significant depression and anxiety symptoms with Hospital Anxiety and Depression rating scale (HADS) -anxiety or -depression subscale score > 8 received 6 weekly group-sessions of ATT in an open trial. Outcomes included feasibility and symptoms measured by HADS, at baseline, post-treatment and at 6 months follow-up. We also assessed psychiatric diagnoses, type D personality, insomnia, worry, and rumination. Results The sample comprised five men with a mean age of 59.9 (SD 4.4) years. Four of the patients attended all six sessions, and one patient attended all but one session. Mean HADS-A scores at baseline, post-treatment, and follow-up were 9.4 (SD 3.0), 4.2 (SD 3.0), and 4.0 (SD 2.5), and for HADS-D 8.6 (SD 3.3), 3.0 (SD 3.7), and 1.6 (SD 1.5), respectively. The results showed clinically significant changes in anxiety, depression, psychiatric disorders, insomnia, worry, and rumination. Statistically significant changes were found from pre- to post-treatment scores for HADS-A and worry, which were maintained at follow-up, and HADS-D scores significantly decreased from pre-treatment to 6-months follow-up. Conclusions ATT in a group format appears to be a feasible stand-alone metacognitive treatment for CHD patients. An adequately powered randomized controlled trial is warranted.
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Affiliation(s)
- Toril Dammen
- Department of Behavioural Medicine, Faculty of Medicine, Insitute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristoffer Tunheim
- Department of Behavioural Medicine, Faculty of Medicine, Insitute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Drammen Hospital, Drammen, Norway
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Grasso JR, Chen SY, Schneider R. Examining changes in presenteeism and clinical symptoms in a workforce mental health benefits program. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2022. [DOI: 10.1080/15555240.2022.2097087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hamdani SU, Huma ZE, Tamizuddin-Nizami A, Baneen UU, Suleman N, Javed H, Malik A, Wang D, Mazhar S, Khan SA, Minhas FA, Rahman A. Feasibility and acceptability of a multicomponent, group psychological intervention for adolescents with psychosocial distress in public schools of Pakistan: a feasibility cluster randomized controlled trial (cRCT). Child Adolesc Psychiatry Ment Health 2022; 16:47. [PMID: 35729589 PMCID: PMC9210054 DOI: 10.1186/s13034-022-00480-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Child and adolescent mental health problems are a global public mental health priority. However, there is a lack of evidence-based scalable psychological interventions for adolescents living in low resource settings. This trial was designed to evaluate the feasibility and acceptability of delivering the World Health Organization's Early Adolescent Skills for Emotions (EASE) intervention at public schools in a rural sub-district in Rawalpindi, Pakistan. METHODS A two arm, single blinded, feasibility cluster randomized controlled trial with mixed-methods evaluation was conducted with 59 adolescents and their caregivers from 8 public schools. In the 4 intervention arm schools, 6 non-specialist facilitators delivered the culturally-adapted EASE group sessions to the adolescents (n = 29) and their caregivers with desired fidelity under the supervision of in-country supervisors. RESULTS The participation rate of adolescents in the intervention sessions was 83%. The intervention strategies were implemented by the adolescents. However, attending biweekly sessions at schools was challenging for caregivers with only 50% caregivers attending the sessions. CONCLUSIONS The results of this study support the feasibility and acceptability of delivering this culturally adapted intervention through non-specialist facilitators in school settings in Pakistan and pave the way to conduct a fully powered cluster randomized controlled trial to test the effectiveness of intervention to improve psychological outcomes in adolescents. Trial registration Trial registered with Clinicaltrials.gov prospectively; NCT04254393.
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Affiliation(s)
- Syed Usman Hamdani
- Human Development Research Foundation (HDRF), Islamabad, Pakistan. .,Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK. .,Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan. .,Benazir Bhutto Hospital, Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan.
| | - Zill-e Huma
- grid.490844.5Human Development Research Foundation (HDRF), Islamabad, Pakistan ,grid.10025.360000 0004 1936 8470Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK ,grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Asad Tamizuddin-Nizami
- grid.415712.40000 0004 0401 3757Benazir Bhutto Hospital, Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Um-ul Baneen
- grid.490844.5Human Development Research Foundation (HDRF), Islamabad, Pakistan ,grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Nadia Suleman
- grid.490844.5Human Development Research Foundation (HDRF), Islamabad, Pakistan ,grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Hashim Javed
- grid.490844.5Human Development Research Foundation (HDRF), Islamabad, Pakistan ,grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Duolao Wang
- grid.48004.380000 0004 1936 9764Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Samra Mazhar
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Shahzad Alam Khan
- grid.475671.6World Health Organization (WHO), Pakistan Office, Islamabad, Pakistan
| | - Fareed Aslam Minhas
- grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Atif Rahman
- grid.10025.360000 0004 1936 8470Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Failure in psychotherapy: a qualitative comparative study from the perspective of patients diagnosed with depression. COUNSELLING PSYCHOLOGY QUARTERLY 2022. [DOI: 10.1080/09515070.2022.2047614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Longitudinal Assessment of a Manualized Group Treatment Program for Gambling Disorder: The Ohio Problem Gambling Treatment Model for Adults with Co-Occurring Disorders. J Gambl Stud 2022; 38:1493-1502. [PMID: 34973141 DOI: 10.1007/s10899-021-10089-0] [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: 11/14/2021] [Indexed: 10/19/2022]
Abstract
Individuals with gambling disorder (GD) experience a host of negative psychosocial and physical health outcomes, yet few seek treatment. Of particular concern are individuals with co-occurring mental and behavioral health disorders, a group at higher risk for GD in the state of Ohio. To better serve this population, the Ohio Department of Mental Health and Addiction Services developed a group-based GD treatment manual for adults with co-occurring disorders. Over the course of 5 years, 353 individuals engaged in at least some of the manual's 12 weekly modules, and more than one-third (n = 122) completed the entire curriculum. Participants who completed all 12 modules completed pre-and post-tests, and after controlling for covariates, participants significantly decreased their GD symptom severity, though changes in self-esteem and gambling urges were non-significant. These findings suggest the treatment manual holds promise at reducing gambling behaviors for individuals with co-occurring disorders, but further research is warranted to explore best practices on how to intervene on the psychological antecedents to gambling in this population.
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Xiang X, Kayser J, Sun Y, Himle J. Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants' Experiences. JMIR Aging 2021; 4:e27630. [PMID: 34813491 PMCID: PMC8663658 DOI: 10.2196/27630] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/22/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is common among homebound older adults. Internet-based cognitive behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities. OBJECTIVE This study aims to understand the experiences of homebound older adults who participated in a pilot feasibility trial of an iCBT for depression. METHODS The participants included 21 homebound older adults who participated in a generic iCBT program that was not specifically designed for older adults and 8 home care workers who assisted in the iCBT program. Informants completed semistructured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questionings of the initial codes. The data analysis was conducted by using dedoose, a web app for mixed methods research. RESULTS Three themes and various subthemes emerged related to participants' experience of the iCBT intervention, as follows: intervention impact, which involved subthemes related to participants' perceived impact of the intervention; challenges and difficulties, which involved subthemes on the challenges and difficulties that participants experienced in the intervention; and facilitators, which involved subthemes on the factors that facilitated intervention use and engagement. CONCLUSIONS iCBT is a promising intervention for homebound older adults experiencing depression. Home care workers reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence. TRIAL REGISTRATION ClinicalTrials.gov NCT04267289; https://clinicaltrials.gov/ct2/show/NCT04267289.
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Affiliation(s)
- Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Jay Kayser
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Yihang Sun
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Joseph Himle
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
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Oliveira JT, Sousa I, Ribeiro AP, Gonçalves MM. Premature termination of the unified protocol for the transdiagnostic treatment of emotional disorders: The role of ambivalence towards change. Clin Psychol Psychother 2021; 29:1089-1100. [PMID: 34791753 DOI: 10.1002/cpp.2694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/13/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022]
Abstract
Ambivalence towards change is an expected, recurrent process in psychological change. However, the prolonged experience of ambivalence in psychotherapy contributes to client disengagement, which could result in treatment dropout. Considering the negative effects of premature termination of therapy and the convenience of the identification of clients who are at risk of dropping out before achieving good-outcome, the current study explored the predictive power of ambivalence for premature therapy termination using a multilevel time-backwards model (i.e., considering the session of the dropout as session zero and then modelling what occurred from the dropout until session 1). Participants included a total of 96 psychotherapy clients (38 dropouts) treated in a university-based clinic following the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Multilevel modelling using a time-backwards model to analyse dropout data provided evidence of the predictive power of ambivalence evolution throughout treatment on the decision to prematurely discontinue treatment (p < .0001; R2 adj = .29). Specifically, good-outcome dropouts presented a decreasing ambivalence trend throughout treatment, whereas poor-outcome dropouts tended to experience the same levels of ambivalence before deciding to drop out (time × dropout; β11 = .64, p = .014). Additionally, poor-outcome dropouts presented higher levels of ambivalence (β01 = 9.92, p < .0001) in the last session. The results suggest that the pattern of client ambivalence towards change is a predictor of premature termination of therapy. Implications for clinical and research contexts are discussed.
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Affiliation(s)
- João Tiago Oliveira
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Inês Sousa
- Department of Mathematics, University of Minho, Braga, Portugal
| | - António P Ribeiro
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Miguel M Gonçalves
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal
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Fredum HG, Rost F, Ulberg R, Midgley N, Thorén A, Aker JFD, Johansen HF, Sandvand L, Tosterud L, Dahl HSJ. Psychotherapy Dropout: Using the Adolescent Psychotherapy Q-Set to Explore the Early In-Session Process of Short-Term Psychodynamic Psychotherapy. Front Psychol 2021; 12:708401. [PMID: 34744869 PMCID: PMC8568886 DOI: 10.3389/fpsyg.2021.708401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Research suggests that short-term psychodynamic psychotherapy (STPP) is an effective treatment for depression in adolescence, yet treatment dropout is a major concern and what leads to dropout is poorly understood. Whilst studies have begun to explore the role of patient and therapist variables, there is a dearth of research on the actual therapy process and investigation of the interaction between patient and therapist. This study aims to address this paucity through the utilisation of the Adolescent Psychotherapy Q-set (APQ) to examine the early treatment period. The sample includes 69 adolescents aged 16-18 years with major depressive disorder receiving STPP as part of the First Experimental Study of Transference Work-in Teenagers (FEST-IT) trial. Of these, 21 were identified as dropouts and were compared to completers on pre-treatment patient characteristics, symptomatology, functioning, and working alliance. APQ ratings available for an early session from 16 of these drop out cases were analysed to explore the patient-therapist interaction structure. Results from the Q-factor analysis revealed three distinct interaction structures that explained 54.3% of the total variance. The first described a process of mutual trust and collaboration, the second was characterised by patient resistance and emotional detachment, the third by a mismatch and incongruence between therapist and adolescent. Comparison between the three revealed interesting differences which taken together provide further evidence that the reasons why adolescents drop out of therapy vary and are multidimensional in nature.
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Affiliation(s)
| | - Felicitas Rost
- Portman Clinic, The Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Randi Ulberg
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Vestfold Hospital Trust, Division of Mental Health, Research Unit, Tønsberg, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Nick Midgley
- Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, London, United Kingdom
| | | | | | | | - Lena Sandvand
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Lina Tosterud
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Hanne-Sofie Johnsen Dahl
- Department of Psychology, University of Oslo, Oslo, Norway
- Vestfold Hospital Trust, Division of Mental Health, Research Unit, Tønsberg, Norway
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Fenski F, Rozental A, Heinrich M, Knaevelsrud C, Zagorscak P, Boettcher J. Negative effects in internet-based interventions for depression: A qualitative content analysis. Internet Interv 2021; 26:100469. [PMID: 34754755 PMCID: PMC8564554 DOI: 10.1016/j.invent.2021.100469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 09/30/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022] Open
Abstract
An increasing number of studies is proving the efficacy of Internet-based interventions (IBI) for treating depression. While the focus of most studies is thereby lying on the potential of IBI to alleviate emotional distress and enhance well-being, few studies are investigating possible negative effects that might be encountered by participants. The current study was therefore exploring self-reported negative effects of participants undergoing a cognitive-behavioral IBI targeting mild to moderate depression over 6 weeks. Data from the client pool of a German insurance company (n = 814, 68% female) revealed that 8.6% of the participants reported the experience of negative effects. Qualitative content analysis yielded two broad categories and five subcategories for the nature of participants' experiences of negative effects: participant-related negative effects (insight and symptom) and program-related negative effects (online format, contact, and implementation). By using both, qualitative and quantitative methods, results did not only shed light on the characteristics of negative effects but analyses also found that working alliance was a predictor for the experience of negative effects. Monitoring the occurrences of negative effects as well as working alliance throughout treatment was considered essential to help prevent negative effects and attrition among participants undergoing IBI for depression.
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Affiliation(s)
- Friederike Fenski
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany,Corresponding author.
| | - Alexander Rozental
- Department of Psychology, Upsala University, Von Kraemers allé 1A, 752 37 Uppsala, Sweden
| | - Manuel Heinrich
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Pavle Zagorscak
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Johanna Boettcher
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Am Köllnischen Park 1, 10179 Berlin, Germany,Division of Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
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Swift JK, Trusty WT, Penix EA. The effectiveness of the Collaborative Assessment and Management of Suicidality (CAMS) compared to alternative treatment conditions: A meta-analysis. Suicide Life Threat Behav 2021; 51:882-896. [PMID: 33998028 DOI: 10.1111/sltb.12765] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This meta-analysis aimed to test the efficacy of the Collaborative Assessment and Management of Suicidality (CAMS) intervention against other commonly used interventions for the treatment of suicide ideation and other suicide-related variables. METHOD Database, expert, and root and branch searches identified nine empirical studies that directly compared CAMS to other active interventions. A random effects model was used to calculate the effect size differences between the interventions; additionally, moderators of the effect sizes were tested for suicidal ideation. RESULTS In comparison to alternative interventions, CAMS resulted in significantly lower suicidal ideation (d = 0.25) and general distress (d = 0.29), significantly higher treatment acceptability (d = 0.42), and significantly higher hope/lower hopelessness (d = 0.88). No significant differences for suicide attempts, self-harm, other suicide-related correlates, or cost effectiveness were observed. The effect size differences for suicidal ideation were consistent across study types and quality, timing of outcome measurement, and the age and ethnicity of participants; however, the effect sizes favoring CAMS were significantly smaller with active duty military/veteran samples and with male participants. CONCLUSIONS The existing research supports CAMS as a Well Supported intervention for suicidal ideation per Center of Disease Control and Prevention criteria. Limitations and future directions are discussed.
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Hatchett GT. Implications of Clinically Significant Change Research for Evidence‐Based Counseling Practice. JOURNAL OF COUNSELING AND DEVELOPMENT 2021. [DOI: 10.1002/jcad.12398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gregory T. Hatchett
- School of Kinesiology, Counseling, and Rehabilitative Science Northern Kentucky University
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Schuler K, Kilmer ED, Callahan J, Dziurzynski K, Swift J. The dose‐effect model is good enough. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Keke Schuler
- Uniformed Services University of the Health Sciences Bethesda MD USA
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Carney DM, Castonguay LG, Janis RA, Scofield BE, Hayes JA, Locke BD. Center Effects: Counseling Center Variables as Predictors of Psychotherapy Outcomes. COUNSELING PSYCHOLOGIST 2021. [DOI: 10.1177/00110000211029271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Treatment context may have a unique impact on psychotherapy outcomes, above and beyond client, therapist, and therapy process variables. University counseling centers represent one such treatment context facing increasing treatment demands. This study examined the role of counseling centers and center variables in explaining differences in psychotherapy outcomes. The Center for Collegiate Mental Health, a large practice–research network, contained data from 116 counseling centers, 2,362 therapists, and 58,423 clients. Multilevel modeling tested if some counseling centers systematically achieved better outcomes than others (a “center effect”). Outcome was operationalized as clients’ magnitude and rate of change in distress across treatment. Results showed a relatively small “center effect” for both outcomes. Analyses sought to explain that center effect through administrative policies and characteristics. As a group, these variables partially explained the center effect. None explained a large portion of total outcome variance. Potential future implications for policy and advocacy efforts are discussed.
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Seow LSE, Sambasivam R, Chang S, Subramaniam M, Lu HS, Assudani HA, Tan CYG, Vaingankar JA. A Qualitative Approach to Understanding the Holistic Experience of Psychotherapy Among Clients. Front Psychol 2021; 12:667303. [PMID: 34421720 PMCID: PMC8377233 DOI: 10.3389/fpsyg.2021.667303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The study of the experience of clients across multiple service encounters (or touchpoints) is important from the perspective of service research. Despite the availability of effective psychotherapies, there exists a significant gap in the optimal delivery of such interventions in the community. Therefore, the aim of this study was to explore the experience of psychotherapy among clients integrating the before-during-after service encounters using a qualitative approach. Methods: A total of 15 clients of outpatient psychotherapy were interviewed, and data saturation was reached. The topics included pathways and reasons to seeking psychotherapy, aspects of the therapy process that have been helpful or unhelpful, and perceived change after receiving psychotherapy. Information was analyzed using the inductive thematic analysis method. Emergent themes pertaining to pre-psychotherapy encounters were mapped onto major components that were identified in Andersen's Health Service Utilization Model. Results: Mental health stigma and the lack of understanding about psychotherapy were the predisposing factors that impeded service use while the preference for non-pharmacological intervention promoted its use. Enabling factors such as affordability and service availability were also of concern, along with perceived and evaluated needs. The attributes of therapists, application of techniques, and the resistance of the client were found to impact the therapeutic alliance. While the majority of the clients experienced positive change or had engaged in self-help strategies after receiving psychotherapy, some cited limited impact on the recovery of symptoms or problematic self-coping without the therapists. Conclusion: This study proposes to expand on Andersen's Behavioral Model by including therapy-related factors so as to provide a more holistic understanding of the use of psychotherapy among the clients. More importantly, the study identified several barriers to access and negative experiences or outcomes, which should be addressed to promote uptake of the psychotherapy intervention.
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Affiliation(s)
| | | | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Huixian Sharon Lu
- Department of Psychology, Institute of Mental Health, Singapore, Singapore
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Gaine GS, Nealis LJ, Zhou H, Purdon SE, Abba-Aji A. Identification of psychiatric inpatient recovery trajectories using routine outcome monitoring with emerging adults. Psychiatry Res 2021; 302:114000. [PMID: 34051677 DOI: 10.1016/j.psychres.2021.114000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
Early intervention for emerging adults with addiction and mental health disorders is beneficial for long-term recovery. The present study investigated the utility of routine outcome monitoring during acute inpatient hospitalization for identifying emerging adults at risk of poor outcomes. This is a retrospective study using latent class growth analysis (LCGA) to identify patient groups with different recovery trajectories, with additional analyses to clarify the characteristics of these trajectory groups. The results identified four patient groups: Rapid responders (38%), gradual responders (34%), high distress non-responders (9%), and low distress non-responders (19%). The high distress non-responding group is characterized by behaviours and disorders associated with ambivalent care seeking: Voluntary admission, longer length of stay, lower service satisfaction, higher outpatient service utilization, elevated risk of emergency department presentation and hospital readmission, and depression/personality disorder diagnosis. The low distress group is characterized by behaviours and disorders associated with treatment rejection: Involuntary admission, shorter length of stay, reduced post-discharge service utilization, and psychotic disorder diagnosis. The results have implications for identifying at-risk youth and developing stepped-care models for more effective and efficient inpatient care.
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Affiliation(s)
- Graham S Gaine
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada; Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Addiction and Mental Health, Edmonton, Alberta, Canada.
| | - Logan J Nealis
- Alberta Health Services, Addiction and Mental Health, Edmonton, Alberta, Canada
| | - Hansen Zhou
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Scot E Purdon
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Addiction and Mental Health, Edmonton, Alberta, Canada
| | - Adam Abba-Aji
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Addiction and Mental Health, Edmonton, Alberta, Canada
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David OA, Cîmpean A, Costescu C, DiGiuseppe R, Doyle K, Hickey M, David D. Effectiveness of Outpatient Rational Emotive Behavior Therapy Over One Decade. Am J Psychother 2021; 74:157-164. [PMID: 34325525 DOI: 10.1176/appi.psychotherapy.20200009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this article was to explore the effectiveness of rational emotive and cognitive-behavioral therapy (REBT) in a clinical setting. METHODS This study included 349 patients of the Albert Ellis Institute who sought psychotherapy from 2007 to 2016. Analyses were conducted by using the intent-to-treat principle, and outcomes were measured after three sessions of therapy (to measure early response) and at the end of 20 sessions. Outcome Questionnaire-45 was used to measure patient functioning. RESULTS Patients reported significant improvements in their functioning after participating in REBT, with a medium effect size for early response after three sessions of psychotherapy and at the end of the 20 sessions. CONCLUSIONS The authors' findings documented that REBT can be effectively transported from a research setting to clinical practice.
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Affiliation(s)
- Oana A David
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania (O. A. David, Cîmpean, Costescu, D. David).,Department of Psychology, St. John's University, New York City (DiGiuseppe).,Albert Ellis Institute, New York City (DiGiuseppe, Doyle, Hickey)
| | - Alina Cîmpean
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania (O. A. David, Cîmpean, Costescu, D. David).,Department of Psychology, St. John's University, New York City (DiGiuseppe).,Albert Ellis Institute, New York City (DiGiuseppe, Doyle, Hickey)
| | - Cristina Costescu
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania (O. A. David, Cîmpean, Costescu, D. David).,Department of Psychology, St. John's University, New York City (DiGiuseppe).,Albert Ellis Institute, New York City (DiGiuseppe, Doyle, Hickey)
| | - Raymond DiGiuseppe
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania (O. A. David, Cîmpean, Costescu, D. David).,Department of Psychology, St. John's University, New York City (DiGiuseppe).,Albert Ellis Institute, New York City (DiGiuseppe, Doyle, Hickey)
| | - Kristene Doyle
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania (O. A. David, Cîmpean, Costescu, D. David).,Department of Psychology, St. John's University, New York City (DiGiuseppe).,Albert Ellis Institute, New York City (DiGiuseppe, Doyle, Hickey)
| | - Michael Hickey
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania (O. A. David, Cîmpean, Costescu, D. David).,Department of Psychology, St. John's University, New York City (DiGiuseppe).,Albert Ellis Institute, New York City (DiGiuseppe, Doyle, Hickey)
| | - Daniel David
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania (O. A. David, Cîmpean, Costescu, D. David).,Department of Psychology, St. John's University, New York City (DiGiuseppe).,Albert Ellis Institute, New York City (DiGiuseppe, Doyle, Hickey)
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Gavin B. When One Size Doesn’t Fit All: Some effects and consequences of short contract student counselling. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Bea Gavin
- School of Nursing Psychotherapy and Community Health Dublin City University Dublin Ireland
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41
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Campbell K, Lakeman R. Borderline Personality Disorder: A Case for the Right Treatment, at the Right Dose, at the Right Time. Issues Ment Health Nurs 2021; 42:608-613. [PMID: 33090931 DOI: 10.1080/01612840.2020.1833119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is now compelling evidence that a range of psychotherapeutic treatments are effective in the treatment of borderline personality disorder (BPD). Such treatments are often lengthy, expensive, subject to high rates of incompletion and are rarely available to people with sub-threshold symptoms. There is broad agreement that some combination of vulnerability, invalidating environment, childhood adversity, disrupted attachment in childhood or trauma play a role in the aetiology of the syndrome of BPD. These factors also contribute to problems with the capacity to mentalise, regulate emotions, tolerate distress and impact on psychosocial development with or without self-damaging and suicidal behaviour. This column takes as a given that people with BPD should receive evidence-based psychological treatments such as dialectical behaviour therapy (DBT), interpersonal therapy and cognitive behavioural therapy in a sufficient dose to be helpful. However, to avert an escalating trajectory which may lead to a diagnosis of BPD the right dose of the right therapy at the right time is necessary. Under-dosing or ineffective psychotherapy can be potentially harmful. This column reviews the evidence, such as it is, for therapeutic approaches which may contribute to more skilful negotiation of life's difficulties and which may avert deterioration in mental health and quality of life in vulnerable individuals and families.
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Affiliation(s)
- Katrina Campbell
- Faculty of Science, Health, Education and Engineering, School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia.,Faculty of Health Sciences, Lecturer School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
| | - Richard Lakeman
- School of Health and Human Services, Southern Cross University, Lismore, Australia
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Ey PhD S, Ladd PhD B, Soller Md M, Moffit PhD M. Seeking Help in the "Perfect Storm": Why Residents and Faculty Access an On-Site Wellness Program. Glob Adv Health Med 2021; 10:21649561211017471. [PMID: 34104576 PMCID: PMC8145605 DOI: 10.1177/21649561211017471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/31/2021] [Accepted: 04/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background In the face of significant distress among physicians, access to counseling is critical. Objective An on-site wellness program for physicians-in-training and faculty was assessed by examining (a) were participants representative of those eligible for services and (b) demographic and trainee vs. faculty differences in burnout, distress, suicide risk, and presenting concerns of participants who utilized services. Methods From 2013–2018, 73% (N = 468; 316 residents/fellows, 152 faculty) of individuals seeking services also consented to research. At intake, participants completed a distress measure (ACORN) and two items from the Maslach Burnout Inventory (MBI), and clinicians categorized presenting concerns and suicide risk. Using Chi-square analyses, participants’ characteristics were compared to physicians eligible for treatment. The association between demographics, faculty vs. trainee status, specialty, and distress, burnout, suicide risk, and presenting concerns was evaluated with ANOVAs and logistic regressions. Results Women, trainees, and primary care physicians were more likely to access services. On the ACORN, 63% were in the clinical range (M =1.7, SD =0.6). On the MBI, 36% scored in the clinical range. Clinicians rated 9% of participants with suicide risk. Neither gender, racial/ethnic minority status, nor specialty were associated with distress, burnout or suicide risk. Trainees reported greater distress than faculty (F (1,447) = 8.42, P = .004, ηp2 = .018). Participants reported multiple presenting concerns (M = 3.0, SD = 1.18) with faculty more commonly endorsing work-related issues. Trainees more commonly reported new or worsening psychological symptoms, performance and family concerns. Conclusions Two physician groups which often report higher levels of burnout and distress when surveyed, women physicians and residents/fellows, were the most likely to get professional help in an on-site wellness program. Physician wellness programs need to be prepared to address work and personal stressors and different levels of distress and risk.
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Affiliation(s)
- Sydney Ey PhD
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
| | - Benjamin Ladd PhD
- Department of Psychology, Washington State University Vancouver, Vancouver, Washington
| | - Marie Soller Md
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
| | - Mary Moffit PhD
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
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Abstract
ZusammenfassungDas Scheitern von Psychotherapien taucht als Thema in der Psychotherapieforschung zwar immer wieder auf, wird aber erst in jüngster Zeit intensiver beforscht, u. a. im Hinblick auf die Frage, wie Scheitern zu definieren ist, wie häufig es vorkommt und welche Variablen Scheitern vorhersagen können. In dieser Übersicht folgt auf eine historische Übersicht mit starkem Bezug auf die Untersuchungen von Hans H. Strupp eine Zusammenfassung systematischer und fallorientierter Betrachtungen von Scheitern in der Psychotherapie. Es werden Studien berichtet, zu den Determinanten und Risikofaktoren von Scheitern sowie zu der Frage, wie der aktuelle Wissensstand zum Scheitern in der psychotherapeutischen Praxis sowohl im klinischen Alltag wie auch in der Aus- und Weiterbildung von psychotherapeutisch Tätigen nutzbar gemacht werden kann.
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Shim Y, Scotney VS, Tay L. Conducting mobile-enabled ecological momentary intervention research in positive psychology: key considerations and recommended practices. THE JOURNAL OF POSITIVE PSYCHOLOGY 2021. [DOI: 10.1080/17439760.2021.1913642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Yerin Shim
- Department of Psychology, Chungnam National University, Daejeon, South Korea
| | | | - Louis Tay
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
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45
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Espiridion ED, Oladunjoye AO, Millsaps U, Yee MR. A Retrospective Review of the Clinical Significance of the Outcome Questionnaire (OQ) Measure in Patients at a Psychiatric Adult Partial Hospital Program. Cureus 2021; 13:e13830. [PMID: 33859892 PMCID: PMC8038917 DOI: 10.7759/cureus.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Outcome Questionnaire (OQ) measure is becoming a more popular assessment tool for monitoring treatment progress in psychiatry at different settings including inpatient and outpatient settings. It can also be used in non-clinical populations. However, little is known about the evaluation of this tool in the Adult Partial Hospital Program (PHP). Methods We conducted a study among patients in an Adult PHP where we extracted data from the OQ analysis program recorded for patients from January 1, 2015 to July 31st, 2020. Results We studied a total of 742 patients among which 509 (68.4%) were males. The mean age was 38.58 ± 14.86 years. Most of the patients had depressive disorder (56.9%). The mean numbers of days on admission were 17.37 ± 25.29 days. There is a consistent decrease in the total score average OQ score from initial to final measure with the year 2019 being 31.99 followed by 2017 (30.05) then 2020 (29.56) then 2015/2016 (28.38) and 2018 (27.27) p < 0.001. Also, for treatment progress it was observed that in years 2015/2016, there was significant improvement in 71.67% of the patients; in 2017, there was significant improvement in 78.53% of the patients; in 2018, there was significant improvement in 77.71% of the patients; while in 2019, there was significant improvement in 76.05% of the patients, and in 2020, there was significant improvement in 70.18% of the patients. Conclusion The direct benefit of the OQ measure to patients is to provide objective measurements of assessing clinical improvement or deterioration in the treatment progress of their clinical condition. Our study has proved that this is a useful tool to assess such in the Adult PHP.
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Affiliation(s)
- Eduardo D Espiridion
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA.,Psychiatry, West Virginia School of Osteopathic Medicine, Lewisburg, USA.,Psychiatry, West Virginia University School of Medicine, Martinsburg, USA.,Psychiatry, Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,Psychiatry, Reading Hospital Tower Health, West Reading, USA
| | - Adeolu O Oladunjoye
- Medical Critical Care, Boston Children's Hospital, Boston, USA.,Psychiatry, Reading Hospital Tower Health, West Reading, USA
| | - Udema Millsaps
- Psychiatry, Reading Hospital Tower Health, West Reading, USA
| | - Maria Ruiza Yee
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA.,Psychiatry, Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,Psychiatry, Reading Hospital Tower Health, West Reading, USA
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46
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Meier ST. Client attendance measures in counselling psychology trainees. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Scott T. Meier
- Department of Counseling, School, & Educational Psychology University at Buffalo Buffalo NY USA
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47
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Cooper D, Champion SM, Stavropoulos L, Grisham JR. How technology can enhance treatment: A scoping review of clinical interventions for anxiety and obsessive-compulsive spectrum disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61 Suppl 1:8-30. [PMID: 33570762 DOI: 10.1111/bjc.12279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Researchers are increasingly investigating how technology could be used to improve the efficacy of treatment for anxiety and obsessive-compulsive (OC) spectrum disorders. A broad range of technologies, disorders and therapeutic processes have been examined in the literature. This review summarizes the evidence for using technology in clinical interventions for anxiety and OC-spectrum disorders and highlights research gaps that should be addressed to improve the evidence base. METHODS A scoping review was conducted based on systematic searches of three databases. Broadly, the criteria included interventions that had integrated technology into clinical contexts to enhance treatment for anxiety and OC-spectrum disorders. All records were double-screened by two reviewers, and data were extracted on the characteristics of interventions, symptom outcomes, and implementation factors. RESULTS Searches returned 2,475 studies, of which 117 were eligible for inclusion in this review. Although almost all studies reported pre-post-symptom reductions, only one quarter of the controlled studies demonstrated additive effect of technology-based interventions in between-group analyses. We noted a trend in underreporting implementation factors. CONCLUSIONS Technology-based interventions can improve the efficacy of treatment for anxiety and OC-spectrum disorders, but there are challenges to achieving this goal. Based on a review of the included studies, we provide four specific recommendations to improve the quality and likelihood of success of future research projects. PRACTITIONER POINTS Technology-based adjuvants are unlikely to improve the efficacy of treatment for anxiety or OC-spectrum disorders based on their novelty or convenience alone. A subset of studies gives hope that specific innovations can improve treatment when targeting a therapeutic process that has been problematic. Clinicians seeking to improve the efficacy of their treatment should first define client-specific therapeutic factors (e.g., homework compliance) that could be leveraged, then apply a specific innovation to address this factor.
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Affiliation(s)
- David Cooper
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sophie M Champion
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren Stavropoulos
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica R Grisham
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
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Lin T, Farber BA. Trajectories of depression in psychotherapy: How client characteristics predict clinical improvement. J Clin Psychol 2021; 77:1354-1370. [PMID: 33538344 DOI: 10.1002/jclp.23119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/18/2020] [Accepted: 01/20/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The current study aims to ascertain the trajectories of psychotherapy clients' symptom change and identify client factors that predict treatment outcome. METHOD We conducted a latent growth mixture model (LGMM) to identify the change trajectories of 44 clients' depression scores during psychotherapy. Client characteristics were then explored to determine whether any were associated with change trajectories. We examined whether the number of physician visits and/or client self-concealment scores predict 63 clients' improvement after controlling for initial symptom severity. RESULTS Two trajectories of clients' symptom change were identified: nonimprovers (52.3%) and improvers (47.7%). Nonimprovers had higher levels of self-concealment and baseline depression than improvers. The number of physician visits was associated with higher depression scores at baseline and greater clinical improvement during psychotherapy. CONCLUSION Clients showed distinct trajectories of symptom change in psychotherapy. Early identification of clients at risk for treatment failure may increase the probability of therapeutic success.
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Affiliation(s)
- Tao Lin
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Barry A Farber
- Teachers College, Columbia University, New York, New York, USA
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Hernandez Hernandez ME, Waller G. Are we on the same page? A comparison of patients' and clinicians' opinions about the importance of CBT techniques. Cogn Behav Ther 2021; 50:439-451. [PMID: 33475024 DOI: 10.1080/16506073.2020.1862292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Clinicians often omit or underuse several techniques while delivering therapy. These omissions can be due to unconscious factors (e.g., clinician's anxiety), or due to clinicians' deliberate decisions (e.g., modifying therapy believing that such modifications are on the patients' best interests). However, little is known about whether patients consider these modifications necessary. The main aim of this study was to explore the opinions about the important aspects of CBT according to both patients' and clinicians' perspectives. It also aimed to determine whether clinicians' anxiety influenced such preferences. To achieve these aims, two groups of participants were approached-CBT clinicians (n = 83) and CBT patients (n = 167). An online survey with a list of techniques commonly used in CBT was developed for each group, who indicated the importance they attributed to the techniques. Additionally, clinicians completed an anxiety measure. Results indicated that clinicians valued all "change-oriented" techniques and several "interpersonal engagement" techniques more than the patients. The only technique preferred by patients was "relaxation". Higher levels of clinician anxiety were associated with a lower preference for "behavioural experiments" and "exposure". In conclusion, clinicians are encouraged to plan therapy in collaboration with the patient, as well as to discuss the rationale for the implemented techniques.
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Affiliation(s)
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, UK
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50
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Allen AB, Robertson E, Patin GA. Improving Emotional and Cognitive Outcomes for Domestic Violence Survivors: The Impact of Shelter Stay and Self-Compassion Support Groups. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP598-NP624. [PMID: 29294950 DOI: 10.1177/0886260517734858] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study examined the effectiveness of a domestic violence shelter and tested the impact of a self-compassion support group curriculum on outcomes valued by shelters such as autonomy, emotional restoration, and safety. Data were collected from 251 women staying in a domestic violence shelter who had the opportunity to attend a self-compassion support group during their stay. Women completed a pre- and posttest survey assessing self-compassion, empowerment, positive emotion, and perceptions of safety. First, women experienced a positive change (N = 36) from pretest to posttest across all four outcome variables, suggesting the domestic violence shelter was effective at improving survivors' well-being. Second, participants who attended a self-compassion support group at least once reported more positive posttest scores compared with those who did not attend a group (N = 79); however, this effect was limited to participants who stayed in shelter a short time. Women who stayed in shelter a longer amount of time experienced more positive posttest scores regardless of group attendance. Although the sample size was limited, analyses directly comparing the traditional shelter support group with the self-compassion support group show that both were equally effective. These findings provide support for shelter effectiveness in terms of improving well-being. They also suggest women who stay in shelter a short period of time may not experience as many shelter benefits unless they attend a support group. Therefore, shelters should consider offering support groups to women very soon after shelter entry. Furthermore, more research is needed to disentangle the benefits of self-compassion interventions over and above a general support group curriculum.
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