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Taher R, Bhanushali P, Allan S, Alvarez-Jimenez M, Bolton H, Dennison L, Wallace BE, Hadjistavropoulos HD, Hall CL, Hardy A, Henry AL, Lane S, Maguire T, Moreton A, Moukhtarian TR, Vallejos EP, Shergill S, Stahl D, Thew GR, Timulak L, van den Berg D, Viganò N, Stock BW, Young KS, Yiend J. Bridging the gap from medical to psychological safety assessment: consensus study in a digital mental health context. BJPsych Open 2024; 10:e126. [PMID: 38828683 DOI: 10.1192/bjo.2024.713] [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] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Digital Mental Health Interventions (DMHIs) that meet the definition of a medical device are regulated by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK. The MHRA uses procedures that were originally developed for pharmaceuticals to assess the safety of DMHIs. There is recognition that this may not be ideal, as is evident by an ongoing consultation for reform led by the MHRA and the National Institute for Health and Care Excellence. AIMS The aim of this study was to generate an experts' consensus on how the medical regulatory method used for assessing safety could best be adapted for DMHIs. METHOD An online Delphi study containing three rounds was conducted with an international panel of 20 experts with experience/knowledge in the field of UK digital mental health. RESULTS Sixty-four items were generated, of which 41 achieved consensus (64%). Consensus emerged around ten recommendations, falling into five main themes: Enhancing the quality of adverse events data in DMHIs; Re-defining serious adverse events for DMHIs; Reassessing short-term symptom deterioration in psychological interventions as a therapeutic risk; Maximising the benefit of the Yellow Card Scheme; and Developing a harmonised approach for assessing the safety of psychological interventions in general. CONCLUSION The implementation of the recommendations provided by this consensus could improve the assessment of safety of DMHIs, making them more effective in detecting and mitigating risk.
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Affiliation(s)
- Rayan Taher
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Palak Bhanushali
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, University of Melbourne, Australia
- Orygen, Parkville, Australia
| | | | | | | | | | - Charlotte L Hall
- NIHR MindTech-MedTech Co-operative, NIHR Nottingham Biomedical Research Centre, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Amy Hardy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Sam Lane
- SilverCloud by Amwell, Boston, USA
| | - Tess Maguire
- School of Psychology, University of Southampton, UK
| | | | - Talar R Moukhtarian
- Mental Health and Wellbeing Unit, Warwick Medical School, University of Warwick, UK
| | - Elvira Perez Vallejos
- NIHR MindTech-MedTech Co-operative, NIHR Nottingham Biomedical Research Centre, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Sukhi Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- Kent and Medway Medical School, Canterbury, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Graham R Thew
- Department of Experimental Psychology, University of Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, Netherlands
| | | | - Ben Wensley Stock
- University of Oxford Medical Sciences Division, University of Oxford, UK
| | - Katherine S Young
- SilverCloud by Amwell, Boston, USA
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Jenny Yiend
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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2
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Piil K, Locatelli G, Skovhus SL, Tolver A, Jarden M. A Shifting Paradigm Toward Family-Centered Care in Neuro-Oncology: A Longitudinal Quasi-Experimental Mixed-Methods Feasibility Study. JOURNAL OF FAMILY NURSING 2024; 30:127-144. [PMID: 38531858 DOI: 10.1177/10748407241236678] [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: 03/28/2024]
Abstract
Family-centered intervention can help families facing illness-related issues. We investigated the feasibility of Family and Network Conversations (FNCs) in high-grade glioma patients and their families. Quasi-experimental feasibility study with longitudinal mixed-methods design. Patients and families were invited to three FNCs over 1 year. They completed questionnaires at four time points and expressed their perspectives on the intervention through telephone interviews. Nurses' perspectives were collected in a focus group. Twenty-one patients and 47 family members were included. On average, patients were 66 years old, mainly male, married, living with caregivers, with unifocal cancer. On average, caregivers were 47 years old, mainly female, being spouses or children of the patient. Quantitative and qualitative data did not always match and expanded each other. Nurse-delivered FNCs holistically addressed families' needs while strengthening family's dialogue and union. Nurses felt empowered, underling that advanced competencies were required. Nurse-delivered FNCs are feasible to provide family-centered care, but they should be tailored to each family's needs.
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Affiliation(s)
- Karin Piil
- Copenhagen University Hospital, Rigshospitalet, Denmark
- Roskilde University, Denmark
| | | | | | | | - Mary Jarden
- Copenhagen University Hospital, Rigshospitalet, Denmark
- University of Copenhagen, Denmark
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Vybíral Z, Ogles BM, Řiháček T, Urbancová B, Gocieková V. Negative experiences in psychotherapy from clients' perspective: A qualitative meta-analysis. Psychother Res 2024; 34:279-292. [PMID: 37410872 DOI: 10.1080/10503307.2023.2226813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE A considerable number of clients report adverse or unwanted effects of psychological treatments. This study aimed to synthesize the findings of qualitative studies focused on what clients perceive as negative experiences in psychotherapy. METHOD A database search was conducted to find primary studies, and a qualitative meta-analysis was used to aggregate the findings on the kinds of negative experiences psychotherapy clients reported. RESULTS A total of 936 statements were extracted from 51 primary studies and categorized into 21 meta-categories, some of which were further divided into subcategories. These meta-categories covered clients' experiences, which fell into four broad clusters: therapists' misbehaviour, hindering aspects of the relationship, poor treatment fit, and negative impacts of treatment. CONCLUSION Clients' negative experiences of psychotherapy are a vast and heterogeneous area, the breadth of which is not captured by any single study. By synthesizing the findings of many primary studies, this meta-analysis represents the most comprehensive summary of these experiences to date.
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Affiliation(s)
- Zbyněk Vybíral
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Benjamin M Ogles
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Barbora Urbancová
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Veronika Gocieková
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
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Honkalampi K, Urhonen HR, Virtanen M. Negative effects in randomized controlled trials of psychotherapies and psychological interventions: A systematic review. Psychother Res 2024:1-12. [PMID: 38266653 DOI: 10.1080/10503307.2024.2301972] [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: 05/29/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Background: Psychotherapy is a key evidence-based method for the treatment of mental disorders. However, little research has been published on the negative effects of psychotherapies. Aims: We examined this issue through a systematic literature review of previous systematic reviews on randomized controlled trials (RCTs). Methods: We focused on previous reviews and meta-analyses on 1) RCTs examining the effectiveness of psychotherapies and 2) previous reviews and meta-analyses specifically focusing on the negative effects of psychotherapy. We included publications published in PubMed and the Cochrane Databases from the year 2000 or later. Results: Of the 1,430 relevant publications, only a small proportion (30%) mentioned negative outcomes, mostly withdrawal. Only 57 of the extracted original studies monitored potential negative effects, and only three small-scale studies indicated negative effects. Conclusions: The systematic monitoring of negative effects in psychotherapy has not been given the same attention as has been given to the benefits of therapy.
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Affiliation(s)
- Kirsi Honkalampi
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Henna-Riikka Urhonen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
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5
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Taher R, Hsu CW, Hampshire C, Fialho C, Heaysman C, Stahl D, Shergill S, Yiend J. The Safety of Digital Mental Health Interventions: Systematic Review and Recommendations. JMIR Ment Health 2023; 10:e47433. [PMID: 37812471 PMCID: PMC10594135 DOI: 10.2196/47433] [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: 03/20/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Evidence suggests that digital mental health interventions (DMHIs) for common mental health conditions are effective. However, digital interventions, such as face-to-face therapies, pose risks to patients. A safe intervention is considered one in which the measured benefits outweigh the identified and mitigated risks. OBJECTIVE This study aims to review the literature to assess how DMHIs assess safety, what risks are reported, and how they are mitigated in both the research and postmarket phases and building on existing recommendations for assessing, reporting, and mitigating safety in the DMHI and standardizing practice. METHODS PsycINFO, Embase, and MEDLINE databases were searched for studies that addressed the safety of DMHIs. The inclusion criteria were any study that addressed the safety of a clinical DMHI, even if not as a main outcome, in an adult population, and in English. As the outcome data were mainly qualitative in nature, a meta-analysis was not possible, and qualitative analysis was used to collate the results. Quantitative results were synthesized in the form of tables and percentages. To illustrate the use of a single common safety metric across studies, we calculated odds ratios and CIs, wherever possible. RESULTS Overall, 23 studies were included in this review. Although many of the included studies assessed safety by actively collecting adverse event (AE) data, over one-third (8/23, 35%) did not assess or collect any safety data. The methods and frequency of safety data collection varied widely, and very few studies have performed formal statistical analyses. The main treatment-related reported AE was symptom deterioration. The main method used to mitigate risk was exclusion of high-risk groups. A secondary web-based search found that 6 DMHIs were available for users or patients to use (postmarket phase), all of which used indications and contraindications to mitigate risk, although there was no evidence of ongoing safety review. CONCLUSIONS The findings of this review show the need for a standardized classification of AEs, a standardized method for assessing AEs to statically analyze AE data, and evidence-based practices for mitigating risk in DMHIs, both in the research and postmarket phases. This review produced 7 specific, measurable, and achievable recommendations with the potential to have an immediate impact on the field, which were implemented across ongoing and future research. Improving the quality of DMHI safety data will allow meaningful assessment of the safety of DMHIs and confidence in whether the benefits of a new DMHI outweigh its risks. TRIAL REGISTRATION PROSPERO CRD42022333181; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=333181.
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Affiliation(s)
- Rayan Taher
- Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Che-Wei Hsu
- Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Chloe Hampshire
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Carolina Fialho
- Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Clare Heaysman
- London Institute for Healthcare Engineering, King's College London, London, United Kingdom
| | - Daniel Stahl
- Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Sukhi Shergill
- Kent and Medway Medical School, Canterbury, Kent, United Kingdom
| | - Jenny Yiend
- Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
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6
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Rønne PF, Esbensen BA, Brødsgaard A, Rosenstrøm SM, Voltelen B, Hansen CA. Barriers and Facilitators Influencing Nurses' Confidence in Managing Family Nursing Conversations in the Treatment of Chronic Noncancer Pain: A Longitudinal Qualitative Study. JOURNAL OF FAMILY NURSING 2023; 29:166-178. [PMID: 36636019 DOI: 10.1177/10748407221145963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This mixed-methods research examined the translation of a family nursing conversation intervention to the multidisciplinary treatment of patients experiencing chronic noncancer pain. The intervention required educating nurses who offered family nursing interventions to these families. The research uncovered barriers and facilitators influencing the nurses' perceived self-efficacy related to the process of incorporating family nursing conversations in their nursing care. A qualitative, descriptive, longitudinal design with three focus group interviews was implemented. A template analysis, using a priori themes based on Bandura's self-efficacy theory, illuminated a process initially predominated by barriers. Learning how to offer family nursing conversations was initially overwhelming for nurses because they were concerned about harming the family. Over time, the nurses came to understand the usefulness of the therapeutic conversation with families. Significant facilitators were the project manager's role, a strong nursing community, and the positive influence of the family intervention on the nurses' professional identity.
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Affiliation(s)
| | | | - Anne Brødsgaard
- Aarhus University, Emdrup, Denmark
- Copenhagen University Hospital, Hvidovre, Denmark
| | | | | | - Carrinna Aviaja Hansen
- University of Southern Denmark, Odense, Denmark
- Zealand University Hospital, Koege, Denmark
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7
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Konkolÿ Thege B, Emmanuel T, Callanan J, Askland KD. Trans-diagnostic determinants of psychotherapeutic treatment response: The pressing need and new opportunities for a more systematic way of selecting psychotherapeutic treatment in the age of virtual service delivery. Front Public Health 2023; 11:1102434. [PMID: 36926171 PMCID: PMC10013819 DOI: 10.3389/fpubh.2023.1102434] [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: 11/18/2022] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
Numerous forms of psychotherapy have demonstrated effectiveness for individuals with specific mental disorders. It is, therefore, the task of the clinician to choose the most appropriate therapeutic approach for any given client to maximize effectiveness. This can prove to be a difficult task due to at least three considerations: (1) there is no treatment approach, method or model that works well on all patients, even within a particular diagnostic class; (2) several treatments are equally efficacious (i.e., more likely to be effective than no treatment at all) when considered only in terms of the patient's diagnosis; and (3) effectiveness in the real-world therapeutic setting is determined by a host of non-diagnostic factors. Typically, consideration of these latter, trans-diagnostic factors is unmethodical or altogether excluded from treatment planning - often resulting in suboptimal patient care, inappropriate clinic resource utilization, patient dissatisfaction with care, patient demoralization/hopelessness, and treatment failure. In this perspective article, we argue that a more systematic research on and clinical consideration of trans-diagnostic factors determining psychotherapeutic treatment outcome (i.e., treatment moderators) would be beneficial and - with the seismic shift toward online service delivery - is more feasible than it used to be. Such a transition toward more client-centered care - systematically considering variables such as sociodemographic characteristics, patient motivation for change, self-efficacy, illness acuity, character pathology, trauma history when making treatment choices - would result in not only decreased symptom burden and improved quality of life but also better resource utilization in mental health care and improved staff morale reducing staff burnout and turnover.
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Affiliation(s)
- Barna Konkolÿ Thege
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Talia Emmanuel
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | | | - Kathleen D Askland
- Askland Medicine Professional Corporation, Midland, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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8
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Oedegaard CH, Engrebretsen IMS, Veseth M, Blindheim A, Stige B. Health care workers’ perspectives on the challenges and possibilities of music therapy within medication-free treatment services. NORDIC JOURNAL OF MUSIC THERAPY 2022. [DOI: 10.1080/08098131.2022.2115530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Christine Henriksen Oedegaard
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Anne Blindheim
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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Abstract
This study qualitatively examined client's definition and experiences of failed psychotherapy. Thirteen clients were interviewed by phone regarding their experience of failed psychotherapy. Data were analyzed using consensual qualitative research (CQR). Participants defined failed psychotherapy as negatively affecting clients, involving problems in the psychotherapy relationship, and not meeting clients' goals. When describing specific experiences of failed psychotherapy, participants gradually recognized the failure themselves, but the recognition was sometimes facilitated by others. Pre-termination, the failed psychotherapy yielded negative effects (worsened symptoms/functioning, deteriorating relationship, not addressing clients' concerns). Participants perceived therapists' contributions as involving action (insensitive/inappropriate responses to participants' concerns about psychotherapy) and inaction (not managing psychotherapy effectively). They perceived their own contributions as their difficulty voicing their concerns or asserting themselves. Post-termination effects were negative cognitively/affectively (heightened distress), behaviorally (disinterest in seeking mental health services), and interpersonally (relationship difficulties in later psychotherapy); the failed psychotherapy also helped participants pursue their needs in psychotherapy. Failed psychotherapy consisted of problems in the relationship and the treatment not meeting client's goals. Such psychotherapy worsened clients' functioning, further damaged an already tenuous psychotherapy relationship, and both therapists and clients contributed to the failure. After termination, failed psychotherapy yielded cognitive/affective, behavioral, and interpersonal effects.
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10
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Pourová M, Řiháček T, Chvála L, Vybíral Z, Boehnke JR. Negative effects during multicomponent group-based treatment: A multisite study. Psychother Res 2022; 33:282-297. [PMID: 35776667 DOI: 10.1080/10503307.2022.2095237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Objective Negative effects (NEs) in group treatments remain an under-researched area. This study aimed to explore the prevalence of various types of NEs in a multicomponent group-based treatment and to determine their predictors. Method: A total of 330 patients participating in a multicomponent group-based treatment were recruited across seven clinical sites. At the end of treatment, the Negative Effects Questionnaire (NEQ) was used to measure NEs. Item-level descriptive analysis was conducted to explore the prevalence of various types of NEs, and structural equation modeling was used to determine predictors of these NEs. Results: The most frequently reported type of NEs was the worsening of symptoms, and the single most frequently reported item was the resurfacing of unpleasant memories. Predictors of NEs included the overall distress level, alexithymia, attachment avoidance, low working alliance, problem actuation, and worse outcomes; psychological mindedness was a protective factor. Conclusion: Patients who experience higher levels of distress at the beginning of treatment, who perceive the group working alliance as problematic, and who experience high in-session emotional arousal related to their problem seem to be especially prone to reporting NEs. Furthermore, the findings do not support the assumption that NEs are a prerequisite for therapeutic change.Trial registration: ISRCTN.org identifier: ISRCTN13532466.
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Affiliation(s)
- Martina Pourová
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Luboš Chvála
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Zbyněk Vybíral
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Jan R Boehnke
- School of Health Sciences, University of Dundee, Dundee, Scotland
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11
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Flemotomos N, Martinez VR, Chen Z, Singla K, Ardulov V, Peri R, Caperton DD, Gibson J, Tanana MJ, Georgiou P, Van Epps J, Lord SP, Hirsch T, Imel ZE, Atkins DC, Narayanan S. Automated evaluation of psychotherapy skills using speech and language technologies. Behav Res Methods 2022; 54:690-711. [PMID: 34346043 PMCID: PMC8810915 DOI: 10.3758/s13428-021-01623-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 11/08/2022]
Abstract
With the growing prevalence of psychological interventions, it is vital to have measures which rate the effectiveness of psychological care to assist in training, supervision, and quality assurance of services. Traditionally, quality assessment is addressed by human raters who evaluate recorded sessions along specific dimensions, often codified through constructs relevant to the approach and domain. This is, however, a cost-prohibitive and time-consuming method that leads to poor feasibility and limited use in real-world settings. To facilitate this process, we have developed an automated competency rating tool able to process the raw recorded audio of a session, analyzing who spoke when, what they said, and how the health professional used language to provide therapy. Focusing on a use case of a specific type of psychotherapy called "motivational interviewing", our system gives comprehensive feedback to the therapist, including information about the dynamics of the session (e.g., therapist's vs. client's talking time), low-level psychological language descriptors (e.g., type of questions asked), as well as other high-level behavioral constructs (e.g., the extent to which the therapist understands the clients' perspective). We describe our platform and its performance using a dataset of more than 5000 recordings drawn from its deployment in a real-world clinical setting used to assist training of new therapists. Widespread use of automated psychotherapy rating tools may augment experts' capabilities by providing an avenue for more effective training and skill improvement, eventually leading to more positive clinical outcomes.
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Affiliation(s)
- Nikolaos Flemotomos
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA.
| | - Victor R Martinez
- Department of Computer Science, University of Southern California, Los Angeles, CA, 90089, USA
| | - Zhuohao Chen
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Karan Singla
- Department of Computer Science, University of Southern California, Los Angeles, CA, 90089, USA
| | - Victor Ardulov
- Department of Computer Science, University of Southern California, Los Angeles, CA, 90089, USA
| | - Raghuveer Peri
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Derek D Caperton
- Department of Educational Psychology, University of Utah, Salt Lake City, Utah, USA
| | - James Gibson
- Behavioral Signal Technologies Inc., Los Angeles, CA, USA
| | - Michael J Tanana
- College of Social Work, University of Utah, Salt Lake City, Utah, USA
| | - Panayiotis Georgiou
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Jake Van Epps
- University Counseling Center, University of Utah, Salt Lake City, Utah, USA
| | - Sarah P Lord
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Tad Hirsch
- Department of Art + Design, Northeastern University, Boston, Massachusetts, USA
| | - Zac E Imel
- Department of Educational Psychology, University of Utah, Salt Lake City, Utah, USA
| | - David C Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Shrikanth Narayanan
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
- Department of Computer Science, University of Southern California, Los Angeles, CA, 90089, USA
- Behavioral Signal Technologies Inc., Los Angeles, CA, USA
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12
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Ciarrochi J, Hayes SC, Oades LG, Hofmann SG. Toward a Unified Framework for Positive Psychology Interventions: Evidence-Based Processes of Change in Coaching, Prevention, and Training. Front Psychol 2022; 12:809362. [PMID: 35222161 PMCID: PMC8866971 DOI: 10.3389/fpsyg.2021.809362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/14/2021] [Indexed: 01/29/2023] Open
Abstract
Since 2000, research within positive psychology has exploded, as reflected in dozens of meta-analyses of different interventions and targeted processes, including strength spotting, positive affect, meaning in life, mindfulness, gratitude, hope, and passion. Frequently, researchers treat positive psychology processes of change as distinct from each other and unrelated to processes in clinical psychology. This paper presents a comprehensive framework for positive psychology processes that crosses theoretical orientation, links coherently to clinical psychology and its more dominantly "negative" processes, and supports practitioners in their efforts to personalize positive psychological interventions. We argue that a multi-dimensional and multi-level extended evolutionary approach can organize effective processes of change in psychosocial interventions, by focusing interventions on context-appropriate variation, selection, and retention of processes, arranged in terms of key biopsychosocial dimensions across psychological, biophysiological, and sociocultural levels of analysis. We review widely studied positive psychology constructs and programs and show how this evolutionary approach can readily accommodate them and provide a common language and framework for improving human and community flourishing. We conclude that Interventions should start with the person, not the protocol.
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Affiliation(s)
- Joseph Ciarrochi
- Institute of Positive Psychology and Education, Australian Catholic University, Sydney, NSW, Australia
| | - Steven C Hayes
- Department of Psychology, University of Nevada, Reno, NV, United States
| | - Lindsay G Oades
- Centre for Positive Psychology, University of Melbourne, Melbourne, VIC, Australia
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Philipps University Marburg, Marburg, Germany.,Boston University, Boston, MA, United States
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13
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Konkolÿ Thege B, Petroll C, Hunger-Schoppe C, Rivas C, Scholtens S. Eine aktualisierte systematische Übersichtsarbeit zur Wirksamkeit von Familienaufstellungen. PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00521-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Finazzi E, MacBeth A. Service users experience of psychological interventions in primary care settings: A qualitative meta-synthesis. Clin Psychol Psychother 2021; 29:400-423. [PMID: 34260121 DOI: 10.1002/cpp.2650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/07/2022]
Abstract
Primary care mental health services play a crucial role in public mental health by providing local and accessible psychological interventions that meet individuals' needs. Despite growing research investigating service users' perspectives of psychological interventions, a qualitative systematic review in this context is not available. The present meta-synthesis collates the existing articles and gives a thematic synthesis of qualitative studies on service users' experience of psychological interventions in primary care. Multiple databases (CINAHL, EMBASE, PsychINFO, MEDLINE, and Cochrane Library) were searched for published qualitative studies of service users' experiences of psychological interventions delivered in primary care. Articles were included if they met inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme tool. All types of psychological interventions were considered across model and delivery format (e.g., face-to-face, computerised programmes, and group). NVIVO was used to code the dataset and themes were extracted following thematic synthesis. Twenty-two studies were included. Four analytical themes and 10 subthemes emerged. The identified themes were as follows: (1) 'Access and Acceptability: facilitators and barriers', (2) 'Structural aspects'; (3) 'Therapeutic process' and (4) 'Outcomes'. A model of interrelationships between themes is proposed. Findings suggest several 'essential ingredients' across psychological interventions and modalities. The crucial role of relational factors, the importance of assessing service users' perceptions of treatment features (e.g., remote delivery) and of tailoring the intervention to their needs were emphasised. Results also suggest involving service users more in discussions and decisions about psychological interventions offered might enhance access, acceptability, and engagement. Recommendations for practice and research are provided.
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Affiliation(s)
- Emilia Finazzi
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, UK.,Department of Clinical and Counselling Psychology, NHS Grampian, Aberdeen, UK
| | - Angus MacBeth
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, UK
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Stephen S, Bell L, Khan M, Love R, Macintosh H, Martin M, Moran R, Price E, Whitehead B, Elliott R. Comparing helpful and hindering processes in good and poor outcome cases: A qualitative metasynthesis of eight Hermeneutic Single Case Efficacy Design studies. Psychother Res 2021; 32:389-403. [PMID: 34088254 DOI: 10.1080/10503307.2021.1934746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Objective: We tested qualitative metasynthesis of a series of Hermeneutic Single Case Efficacy Design (HSCED) studies as a method for comparing within-session processes that may explain good and poor therapeutic outcome. Method: We selected eight HSCED studies according to change in clients' scores on the Strathclyde Inventory (SI), a brief self-report instrument used to measure outcome in person-centered psychotherapy. Four of the case studies investigated the experience of clients whose pre-post change in SI scores showed improvement by the end of therapy, and the other four focused on clients whose change in SI scores indicated deterioration. We conducted a qualitative metasynthesis, adopting a generic descriptive-interpretive approach to analyze and compare the data generated by the HSCED studies. Results: In contrast to improvers, deteriorators appeared to be less ready to engage in therapeutic work at the beginning of therapy, and found the process more difficult; their therapists were less able to respond to these difficulties in a responsive, empathic manner; deteriorators were less able to cope successfully with changes of therapist and, eventually, gave up on therapy. Conclusion: We found that our qualitative metasynthesis of a series of HSCED studies produced a plausible explanation for the contrasting outcomes that occurred.
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Affiliation(s)
- Susan Stephen
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Laura Bell
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Maha Khan
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Ruth Love
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Hannah Macintosh
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Melanie Martin
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Rebecca Moran
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Emily Price
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Brigid Whitehead
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Robert Elliott
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
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Konkolÿ Thege B, Petroll C, Rivas C, Scholtens S. The Effectiveness of Family Constellation Therapy in Improving Mental Health: A Systematic Review. FAMILY PROCESS 2021; 60:409-423. [PMID: 33528854 DOI: 10.1111/famp.12636] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Family/systemic constellation therapy is a short-term group intervention aiming to help clients better understand and then change their conflictive experiences within a social system (e.g., family). The aim of the present systematic review was to synthetize the empirical evidence on the tolerability and effectiveness of this intervention in improving mental health. The PsycINFO, Embase, MEDLINE, ISI Web of Science, Psyndex, PsycEXTRA, ProQuest Dissertations & Theses, The Cochrane Library, Google Scholar, and an intervention-specific organization's databases were searched for quantitative, prospective studies published in English, German, Spanish, French, Dutch or Hungarian up until April 2020. Out of 4,197 identified records, 67 were assessed for eligibility, with 12 studies fulfilling inclusion criteria (10 independent samples; altogether 568 participants). Outcome variables were diverse ranging from positive self-image through psychopathology to perceived quality of family relationships. Out of the 12 studies, nine showed statistically significant improvement postintervention. The studies showing no significant treatment benefit were of lower methodological quality. The random-effect meta-analysis-conducted on five studies in relation to general psychopathology-indicated a moderate effect (Hedges' g of 0.531, CI: 0.387-0.676). Authors of seven studies also investigated potential iatrogenic effects and four studies reported minor or moderate negative effects in a small proportion (5-8%) of participants that potentially could have been linked to the intervention. The data accumulated to date point into the direction that family constellation therapy is an effective intervention with significant mental health benefits in the general population; however, the quantity and overall quality of the evidence is low.
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Affiliation(s)
- Barna Konkolÿ Thege
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carla Petroll
- Department of Psychology, University of Hamburg, Hamburg, Germany
| | - Carlos Rivas
- Division of Philosophy, Art, and Critical Thought, European Graduate School, Leuk-Stadt, Switzerland
| | - Salome Scholtens
- Department of Health Sciences, University Medical Center Groningen, Groningen, The Netherlands
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Hayes D, Za’ba N. What metrics of harm are being captured in clinical trials involving talking treatments for young people? A systematic review of registered studies on the ISRCTN. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12407] [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)
- Daniel Hayes
- Evidence Based Practice Unit University College London London UK
- Anna Freud National Centre for Children and Families London UK
- Health Service and Population Research Institute of Psychiatry, Psychology and Neuroscience London UK
| | - Nur Za’ba
- Anna Freud National Centre for Children and Families London UK
- Postgraduate Studies University College London London UK
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Priestley M, Broglia E, Hughes G, Spanner L. Student Perspectives on improving mental health support Services at university. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12391] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Emma Broglia
- Department of Psychology University of Sheffield Sheffield UK
- Research Department British Association of Counselling and Psychotherapy Lutterworth UK
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Preventing harm related to CBT supervision: a theoretical review and preliminary framework. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Like any treatment, cognitive behavioural therapy (CBT) may have negative as well as positive outcomes, and the same is true of CBT supervision. This is recognized in definitions of supervision, which prioritize helping supervisees to ‘do no harm’ to their patients. Client harm is associated with personal distress in supervisees (therapists), such as burnout, resulting in sub-standard therapy which causes harm to patients. Some supervisors have contributed to the supervisees’ distress, and consequently to patient harm. Harm may also arise from other staff members, or from situational factors that impact negatively on various aspects of the healthcare environment. At a more distal level, the host organization may create a context that allows such problems to go unchecked (e.g. a failure to train or support supervisors adequately). It follows that a large-scale framework is necessary to fully understand and address this multi-dimensional and systemic context for harm. Therefore, this theoretical review sketches out a preliminary ‘infidelity framework’ in order to classify ten types of problem behaviour that commonly contribute to harm that is linked to supervision. Drawing on related frameworks and neighbouring literatures, the infidelity framework also offers an understanding of the typical antecedents and consequences of each of these ten behaviours. This generic functional analysis leads to examples of evidence-based CBT supervision that might prevent or rectify harm.
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Castro Batic B, Hayes D. Exploring harm in psychotherapy: Perspectives of clinicians working with children and young people. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Dan Hayes
- University College London London UK
- Anna Freud Centre London UK
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Silverman MJ, Gooding LF, Yinger O. It’s...Complicated: A Theoretical Model of Music-Induced Harm. J Music Ther 2020; 57:251-281. [DOI: 10.1093/jmt/thaa008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AbstractWhile literature exists supporting the use of music for health promotion, scholars have also noted the potential for music-induced harm and other maladaptive effects of music. Harm is a multifaceted construct that can include affective, behavioral, cognitive, identity, interpersonal, physical, and spiritual aspects. As music also represents a multifaceted experience, the relationship between music and harm is complex and can include numerous contextual-, deliverer-, music-, and recipient-based factors. Music-induced harm (MIH) also needs to be clearly defined to understand and protect against it. Therefore, the purpose of this article was to explore the numerous factors influencing how music can result in harm and develop a theoretical model that could be used to inform safe music practices. Drawing from existing models of emotional responses to music, music intervention reporting guidelines, therapeutic functions of music, and holistic wellness, we explored how the interplay between the deliverer, music, and recipient can result in various types of MIH in diverse contexts. We then developed the MIH model to integrate these factors and connect the model with the existing literature. The MIH model highlights the relevance of academic and clinical training, credentialing, occupational regulation, continuing education, and professional organizations that provide accredited curricular oversight to protect people from MIH. Implications for clinical application, limitations, and suggestions for future research are provided.
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Moula Z. A systematic review of the effectiveness of art therapy delivered in school-based settings to children aged 5–12 years. INTERNATIONAL JOURNAL OF ART THERAPY 2020. [DOI: 10.1080/17454832.2020.1751219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Zoe Moula
- Faculty of Health Sciences, University of Stirling, Scotland, UK
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The development of a theoretically derived measure exploring extreme appraisals of sleep in bipolar disorder: a Delphi study with professionals. Behav Cogn Psychother 2020; 48:395-407. [PMID: 32157985 DOI: 10.1017/s1352465820000053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sleep and mood are known to be linked and this is particularly evident in people with a diagnosis of bipolar disorder (BD). It has been proposed that psychological interventions improving sleep can be a pathway for improving mood. In order for a psychological sleep intervention to be appropriate, the common cognitive processes maintaining the range of sleep disturbances need to be investigated. AIM This study aimed to explore and identify expert consensus on positive and negative sleep appraisals in the context of low and high mood states, using the Integrative Cognitive Model as a theoretical guide. METHOD A Delphi approach was utilized to allow clinical and research professionals, with experience in the field of BD, to be anonymously consulted about their views on sleep appraisals. These experts were invited to participate in up to three rounds of producing and rating statements that represented positive and negative sleep appraisals. RESULTS A total of 38 statements were developed and rated, resulting in a final list of 19 statements that were rated as 'essential' or 'important' by >80% of the participants. These statements represent the full range of extreme sleep appraisals this study had set out to explore, confirming the importance of better understanding and identifying positive and negative sleep cognitions in the context of high and low mood. CONCLUSION The statements reviewed in this study will be used to inform the development of a sleep cognition measure that may be useful in cognitive therapy addressing sleep disturbances experienced along the bipolar spectrum.
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