Adherence to substance abuse treatment: clinical utility of two MMPI-2 scales

Predicting therapist ratings of treatment progress and outcomes with the MMPI-2-RF

OBJECTIVE

We examined the ability of scores on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scales to predict treatment progress (compliance and activity in therapy) and outcome at termination (success in therapy, readiness for termination, and functioning at termination).

METHOD

Our sample included 448 (185 males, 263 females) community mental health center outpatients with an average age of 32.2 years (standard deviation = 10.2). We used MMPI-2-RF (self-report) indicators of personality and psychopathology and a composite outcome variable that represents therapist ratings of clients' treatment progress and outcomes.

RESULTS

Scores on several MMPI-2-RF scales were correlated and associated with increased risk for poorer psychotherapy progress and outcomes in a mental health outpatient sample.

CONCLUSIONS

Clinicians can utilize the MMPI-2-RF to identify clients at risk for therapy process challenges and adverse outcomes, suggesting possible problem areas for intervention.

Development and Preliminary Validation of the Adherence to Weight Control Questionnaire

BACKGROUND AND PURPOSE

This study tests the psychometric properties of the Adherence to Weight Control Questionnaire, a new screening tool to measure treatment adherence (TAWC) and the risk of nonadherence to weight control (RNAWC) in adolescents.

METHODS

Participants are 92 adolescents (12-18 years old) from a pediatric obesity clinic. Construct validity were evaluated using a principal axis factoring method with varimax rotation. Reliability and criterion-related validity of both scales were also checked.

RESULTS

Both scales presented good reliability values (.770 and .908). Statistical analyses yielded a 1-factor solution for the RNAWC and a 4-factor solution for the TAWC. Criterion-related validity of scales was also checked.

CONCLUSIONS

Results showed that this theory-driven measure of adherence to weight control has adequate psychometric properties to support both research and the clinical practice.

Individuals at Risk for Suicide

BACKGROUND

Individuals experiencing suicidal ideation and/or behaviors are often difficult to engage in treatment. Up to 50% of individuals presenting to an ER for treatment of a suicidal crisis refuse outpatient treatment referrals. This study examined outpatient mental health clinicians' perceptions of the barriers to and facilitators of mental health treatment engagement of individuals at risk for suicide.

METHOD

Thirty-six mental health clinicians working with clients with past and/or current suicidality (ideation, behaviors) in outpatient mental health centers participated in four focus groups. Data were collected using semistructured interview. A process of content analysis was utilized in which data were analyzed thematically.

RESULTS

Five main domains of barriers and facilitators emerged including (a) client-level, (b) clinician-level, (c) service-level, (d) agency-level, and (e) intervention-level variables. In all, 38 barriers and 31 facilitators were identified. The most frequently identified facilitator was the clinician's own sense of engagement with the client, identified by 31% of the clinicians. The most frequently identified barrier was housing instability, identified by 34% of the clinicians.

CONCLUSION

Knowledge of clinicians' perspective on treatment engagement of clients at risk for suicide may inform the development and implementation of interventions and guide training/supervision programs for those working with this vulnerable population.

The incremental validity of the MMPI-2: When does therapist access not enhance treatment outcome?

The present study examined whether therapist access to the Minnesota Multiphasic Personality Inventory (MMPI-2) predicted favorable treatment outcome, above and beyond other assessment measures. A manipulated assessment design was used, in which patients were randomly assigned either to a group in which therapists had access to their MMPI-2 data or to a group without therapist access to such information. Illness severity, improvement ratings, number of sessions attended, and premature termination were indicators of therapy outcome. Results indicated that therapist access to the MMPI-2 data did not add to the prediction of positive treatment outcome beyond that predicted by other measures in this setting. Findings from this initial study suggest that, compared with other resources, perhaps in clinical settings with an emphasis on diagnosis-based and evidence-based treatment, the MMPI-2 may not provide incrementally valid information. However, these effects warrant replication across different settings and samples. Guidelines for future studies are discussed.

Predicting methadone maintenance treatment outcomes using the Addiction Severity Index and the MMPI-2 Content Scales (Negative Treatment Indicators and Cynism scales)

We studied the ability of the Minnesota Multiphasic Personality Inventory-2 Content Scales (Negative Treatment Indicators [TRT] and Cynicism [CYN]) and the domain scales of the Addiction Severity Index (ASI) in predicting outcome from a methadone maintenance program. Participants were 108 African American males treated in a VA health care outpatient methadone maintenance treatment program and followed for up to 1 year after admission. Dependent variables were 1) length of stay and the percentage of 2) missed medication days, 3) toxicology urine samples free from illicit drugs, 4) full-time employment, 5) attendance at scheduled counseling sessions, and 6) counselor ratings of patient progress. A stepwise linear regression equation indicated that low drug severity scores on the ASI and low scores on percentage of missed medication predicted patients who were clean 1 year later; low scores on the psychological domain of the ASI predicted attendance at counseling sessions; a discriminant function analysis (consisting of percent of missed medication, percentage of clean urines, and ratings of patient progress) successfully predicted patient status (i.e., dropouts vs. "active patients") with 85% accuracy. Although the TRT and CYN were related to some ASI domains, they were not associated with any outcome variable. Results suggest that some ASI scores serve as important indicators of patient progress in methadone maintenance treatment.

Predicting the outcome of methadone maintenance treatment with the Negative Treatment Indicators content scale from the MMPI-2

Scores on the Negative Treatment Indicators content scale from the MMPI-2 were not significantly correlated with 5 measures of treatment outcome among 108 male patients on methadone maintenance. These results and those from other studies using this content scale as an independent variable with substance abusers suggest that the scale has yet to demonstrate consistent predictive validity with this population.