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Duong LA, Zoupou E, Boga CI, Kashden J, Fisher J, Connolly Gibbons MB, Crits-Christoph P. Gender, Race/Ethnicity, and Patient-Therapist Matching on Gender and Race/Ethnicity: Predictors/Moderators of the Effectiveness of Trust/Respect Feedback. Adm Policy Ment Health 2024:10.1007/s10488-023-01335-1. [PMID: 38175334 DOI: 10.1007/s10488-023-01335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
A plethora of studies has exhibited the effectiveness of using measurement-based care feedback systems within mental health services to improve treatment outcomes; however, patient gender/race and patient-therapist matching on gender and race remain relatively unexplored as predictors/moderators in feedback studies. We conducted predictor/moderator analyses focusing on the relation of gender, race/ethnicity, and patient-therapist gender and race/ethnicity matching on two outcomes: patient self-reported levels of (1) functioning and (2) trust/respect within the therapeutic relationship. We used data from a randomized controlled trial studying the effectiveness of a feedback system comparing patient-reported levels of trust and respect towards their provider (together with symptom feedback) in comparison to symptom only feedback. We found that men improved in functioning more than women when their therapists received trust/respect feedback compared to symptom only feedback (F[1, 902] = 9.79, p = .002, d = 0.21). We also found that dyads matched on race/ethnicity but not gender, and those matched on gender but not race/ethnicity, improved in functioning over time more than dyads mismatched on both gender and race/ethnicity and those matched on both gender and race/ethnicity (F[1, 897] = 8.63, p = .0034, d = 0.20). On trust/respect outcomes, we found a gender difference over time (F[1, 759] = 6.61, p = .01, d = 0.19), a gender matching difference by feedback condition interaction (F[1, 757] = 5.25, p = .02, d = 0.17), and a racial/ethnic matching difference on trust/respect scores over time (F[1, 785] = 3.89, p = .049, d = 0.14). Male patients showed an initial decrease followed by a steady increase in trust/respect over time while female patients showed an initial increase followed by a steady decrease. Gender-matched therapeutic dyads showed higher levels of trust/respect compared to mismatched dyads when therapists received symptom only feedback, but this difference was not apparent when trust/respect feedback was provided. Dyads mismatched on race/ethnicity improved steadily in trust/respect over time, but matched dyads decreased in trust/respect after an initial increase. Future research should focus on the use of feedback systems to enhance outcomes for patients with specific gender and racial/ethnic identities.
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Affiliation(s)
- Lang A Duong
- Department of Psychiatry, University of Pennsylvania - Perelman School of Medicine, Philadelphia, USA
| | - Eirini Zoupou
- Department of Psychiatry, University of Pennsylvania - Perelman School of Medicine, Philadelphia, USA
| | - Cathryn I Boga
- Department of Psychiatry, University of Pennsylvania - Perelman School of Medicine, Philadelphia, USA
| | - Jody Kashden
- Department of Psychiatry, University of Pennsylvania - Perelman School of Medicine, Philadelphia, USA
- Princeton Behavioral Health, Moorestown and Princeton, Moorestown, NJ, USA
| | - Jena Fisher
- Merakey, Sharon Hill and Philadelphia, PA, USA
| | | | - Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania - Perelman School of Medicine, Philadelphia, USA
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Yaffe-Herbst L, Joffe M, Peysachov G, Nof A, Connolly Gibbons MB, Crits-Christoph P, Zilcha-Mano S. The development of a comprehensive coding system for evaluating insight based on a clinical interview: The SUIP-I coding system. Psychotherapy (Chic) 2023; 60:225-230. [PMID: 37261733 DOI: 10.1037/pst0000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Gaining insight is considered a cornerstone of psychodynamic psychotherapy. Existing tools used to measure insight mainly include patients' self-report questionnaires and external coding of therapy sessions. To expand on the available tools, the present study developed a comprehensive coding system for the Self-Understanding of Interpersonal Patterns Scales-Interview (SUIP-I; Gibbons & Crits-Christoph, 2017). A total of 55 patients enrolled in a randomized controlled trial received psychodynamic psychotherapy for depression and were interviewed using the SUIP-I at baseline. A comprehensive coding system was developed for rating the interviews, based on a Likert scale for each of the six levels of insight. The content validity, psychometric properties, and the reliability and validity of the coding system were examined. The new SUIP-I coding system demonstrated interrater reliability in the "excellent" range, ICC (1, 1) = .91-.97, for all the six levels, and adequate internal consistency (Cronbach's α = .81). Support for convergent validity was gained, as manifested in a significant positive association of the SUIP-I with alliance expectation and affiliation, and a significant negative association with avoidance attachment. Support for discriminant validity was also gained, as manifested in a weak, nonsignificant association between the SUIP-I and self-esteem. The proposed comprehensive coding system shows good initial reliability and validity. Research is needed to further establish the psychometric properties of the new SUIP-I coding system. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Maya Joffe
- The Department of Psychology, University of Haifa
| | | | - Aviv Nof
- The Department of Psychology, University of Haifa
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Goldstein E, King C, Crits-Christoph P, Connolly Gibbons MB. The association between trauma and interpersonal problems in a United States community mental health setting. J Clin Psychol 2023; 79:1192-1207. [PMID: 36459614 DOI: 10.1002/jclp.23467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 10/05/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Previous research has documented associations between trauma and interpersonal problems. We examined the impact of trauma on interpersonal problems among depressed patients seeking treatment in a community mental health setting. METHODS A total of 453 patients seeking treatment and screened for a comparative effectiveness study of therapies for depression were included. We conducted analyses relating the 32-item inventory of interpersonal problems (IIP-32) to trauma measures. RESULTS 99.1% of the sample experienced a traumatic event. There were significant associations between the total number of traumas, the number of sexually and physically assaultive traumas, and both gender and race. The number of sexually assaultive traumas was significantly related to the IIP-32 "too caring" subscale (simple r = 0.167, p < 0.001). Controlling for demographics and other IIP-32 subscales, the total number of traumas remained significantly related to the IIP-32 "too caring" domain (partial r = 0.163, p < 0.001). CONCLUSIONS Traumatic events are prevalent among community populations and these experiences are associated with certain interpersonal problems. Trauma and interpersonal problems are key issues for the treatment of patients in the community mental health setting.
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Affiliation(s)
- Elena Goldstein
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Catherine King
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Crits-Christoph
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Beth Connolly Gibbons
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Connolly Gibbons MB, Duong L, Zoupou E, Kashden J, Fisher J, Crits-Christoph P. Randomized controlled trial evaluating feedback to community-based therapists based on patient reports of trust and respect. J Consult Clin Psychol 2023; 91:337-349. [PMID: 36862463 DOI: 10.1037/ccp0000807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Patient trust/respect toward their therapists may be an important component of patient-therapist relationships. This randomized controlled trial evaluated the impact of providing weekly feedback to therapists regarding patient ratings of trust/respect toward their therapist. METHOD Adult patients seeking mental health treatment at four community clinics (two community mental health centers and two community-based intensive treatment programs) were randomized to either having their primary therapist receive weekly symptom feedback-only or symptoms plus trust/respect feedback. Data were collected both prior to and during COVID-19. The primary outcome measure was a measure of functioning obtained weekly at baseline and the subsequent 11 weeks, with the primary analysis focusing on patients who received any treatment. Secondary outcomes included measures of symptoms and trust/respect. RESULTS Among 233 consented patients, 185 had a postbaseline assessment and were analyzed for the primary and secondary outcomes (median age of 30 years; 5.4% Asian, 12.4% Hispanic, 17.8% Black, 67.0% White, 4.3% more than 1 race, and 5.4% unknown; 64.4% female). On the Patient-Reported Outcomes Measurement Information System Social Roles and Activities scale (primary outcome), the trust/respect plus symptom feedback group had significantly greater improvements over time than the symptom alone feedback group (p = .0006, effect size d = .22). Secondary outcome measures of symptoms and trust/respect also showed statistically significant greater improvement for the trust/respect feedback group. CONCLUSIONS In this trial, trust/respect feedback to therapists was associated with significantly greater improvements in treatment outcomes. Evaluation of the mechanisms of such improvements is needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Crits-Christoph P, Gallop R, Duong L, Zoupou E, Gibbons MBC. Repeated assessments of depressive symptoms in randomized psychosocial intervention trials: best practice for analyzing symptom change over time. Psychother Res 2023; 33:158-172. [PMID: 35544540 PMCID: PMC9649835 DOI: 10.1080/10503307.2022.2073289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Psychotherapy randomized trials rarely have tested for the best fitting model for time effects. We examined the fit of different statistical models for examining time when repeated assessments of depressive symptoms are the primary outcome. METHOD We used data from three studies comparing psychotherapy treatments for major depressive disorder. Outcome measures were self-report ratings for Study 1 (N = 237) and Study 2 (N = 100) and clinician ratings for Study 3 (N = 120) of depressive symptoms measured at every session (Studies 1 and 2) or monthly (Study 3). We examined the fit of the following time patterns: linear, quadratic, cubic, log transformation of time, piece-wise linear, and unstructured. RESULTS In Study 1, a log-linear model had the best fit (Δ Akaike information criterion [AICc] = 7.5). In Study 2, all models had essentially no support (Δ AICcs > 10) in comparison to the best fitting model, which was the unstructured model. In Study 3, the cubic model had the best fit, but it was not significantly better than a log-linear (Δ AICc = 3.5) or unstructured model (Δ AICc = 2.5). CONCLUSIONS Trials should routinely compare different time models, including an unstructured model, when repeated measures of depressive symptoms are the primary outcome.
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Affiliation(s)
| | | | - Lang Duong
- Department of Psychiatry, University of Pennsylvania
| | - Eirini Zoupou
- Department of Psychiatry, University of Pennsylvania
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Gertz AM, Soffi ASM, Mompe A, Sickboy O, Gaines AN, Ryan R, Mussa A, Bawn C, Gallop R, Morroni C, Crits-Christoph P. Developing an Assessment of Contraceptive Preferences in Botswana: Piloting a Novel Approach Using Best-Worst Scaling of Attributes. Front Glob Womens Health 2022; 3:815634. [PMID: 35663924 PMCID: PMC9157818 DOI: 10.3389/fgwh.2022.815634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction To develop an attribute-based method for assessing patient contraceptive preferences in Botswana and pilot its use to explore the relationship between patient contraceptive preferences and the contraceptive methods provided or recommended to patients by clinicians. Methods A list of contraceptive attributes was developed with input from patients, clinicians, and other stakeholders. We assessed patient preferences for attributes of contraceptives using a discrete choice "best-worst scaling" approach and a multi-attribute decision-making method that linked patient attribute preferences to actual contraceptive method characteristics. Attribute-based patient method preferences and clinician recommendations were compared in 100 women seeking contraceptive services, and 19 clinicians who provided their care. For 41 of the patients, the short-term reliability of their preference scores was also examined. Results For 57 patients who wanted more children in the future, the degree of concordance between patients and clinicians was 7% when comparing the top attribute-based contraceptive preference for each woman with the clinician-provided/recommended method. When the top two model-based preferred contraceptive methods were considered, concordance was 28%. For 43 women who did not want more children, concordance was 0% when using the patient's model-based "most-preferred" method, and 14% when considering the top two methods. Assessment of the short-term reliability of preference scores yielded an intraclass correlation coefficient of 0.93. Conclusions A best-worst scaling assessment of attributes of contraceptives was designed and piloted in Botswana as a Contraceptive Preference Assessment Tool. The preference assessment was found to have high short-term reliability, which supports its potential use as a measurement tool. There was very low concordance between women's attribute-based contraceptive preferences and their clinician's provision/recommendations of contraceptive methods. Using such a preference assessment tool could encourage greater patient involvement and more tailored discussion in contraceptive consultations.
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Affiliation(s)
- Alida M. Gertz
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Atlang Mompe
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | - Averi N. Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Rebecca Ryan
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Caitlin Bawn
- Sexual and Reproductive Health Department, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Robert Gallop
- West Chester University, West Chester, PA, United States
| | - Chelsea Morroni
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Medical Research Council (MRC) University of Edinburgh Centre for Reproductive Health, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Paul Crits-Christoph
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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King C, Goldstein E, Crits-Christoph P, Connolly Gibbons MB. The association between medical comorbidity and psychotherapy processes and outcomes for major depressive disorder in a community mental health setting. ACTA ACUST UNITED AC 2021; 59:199-208. [PMID: 34435847 DOI: 10.1037/pst0000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many individuals seeking mental health services for depression often suffer from a comorbid medical condition. The goal of the present study was to assess the presence of medical comorbidity in a community mental health center setting that primarily serves a Medicare and Medicaid population, characterize the types of comorbid medical conditions experienced in this setting, and explore the association between medical conditions on the alliance, attrition from services, and outcome. Medical diagnoses were collected from patient charts and structured clinical interviews from 353 participants who had a baseline assessment as part of a comparative effectiveness study of cognitive and dynamic therapies for major depressive disorder. We calculated the Charlson Comorbidity Index and the number of total medical diagnoses for each patient. Results from this study revealed that a high percentage of patients in this setting experienced a comorbid medical condition. No significant associations were found between the number of medical conditions or the Charlson Comorbidity Index and the alliance. No significant relationship was found between the number of medical conditions or the Charlson Comorbidity Index and early attrition from treatment or treatment outcome. However, exploratory analyses found that presence of a nervous system disorder was associated with relatively poorer treatment outcomes after initial engagement. Implications of these findings are discussed. Treatments for major depressive disorder may benefit from addressing the impact of medical disorders on physical functioning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Jennissen S, Connolly Gibbons MB, Crits-Christoph P, Schauenburg H, Dinger U. Insight as a mechanism of change in dynamic therapy for major depressive disorder. J Couns Psychol 2021; 68:435-445. [PMID: 33970657 DOI: 10.1037/cou0000554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study aimed to investigate change in insight into maladaptive interpersonal patterns over the course of psychotherapy, as well as the specificity of insight as a change mechanism in dynamic treatments. A total of 100 patients received up to 16 sessions of either cognitive or dynamic therapy for major depressive disorder in a randomized clinical trial. Assessments of insight (Insight into Conflictual Relationship Patterns scale) and depression severity (Hamilton Depression Inventory) took place at the beginning of treatment, at month 2, and month 5. Patient insight significantly improved over the course of dynamic treatments. Gains in insight from the beginning to month 2 of treatment were a significant predictor of decreases of depressive symptoms from month 2 to month 5 of treatment in the dynamic, but not in the cognitive treatment group, despite a nonsignificant interaction. Results provide support for insight as a change factor in dynamic therapies. Better self-understanding of dysfunctional interaction patterns could help patients to find more adaptive ways of behaving, to form more satisfying relationships, and to improve their depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Simone Jennissen
- Department of General Internal Medicine and Psychosomatics, Heidelberg University
| | | | | | - Henning Schauenburg
- Department of General Internal Medicine and Psychosomatics, Heidelberg University
| | - Ulrike Dinger
- Department of General Internal Medicine and Psychosomatics, Heidelberg University
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Crits-Christoph P, Goldstein E, King C, Jordan M, Thompson D, Fisher J, Gibbons MBC. A Feasibility Study of Behavioral Activation for Major Depressive Disorder in a Community Mental Health Setting. Behav Ther 2021; 52:39-52. [PMID: 33483123 PMCID: PMC7826447 DOI: 10.1016/j.beth.2020.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
Behavioral activation (BA) is a well-supported treatment approach, but little research has been conducted on the effectiveness of this treatment within publicly funded community mental health settings. We examined the feasibility of conducting a randomized trial examining the effectiveness of nine sessions of BA as a treatment for major depressive disorder (MDD) in a community mental health clinic (CMHC) setting. Following adaptation of a BA manual and training of BA therapists, 80 patients seeking treatment at a CMHC were randomized, with a 3:1 randomization rate of BA to nine sessions of treatment as usual (TAU). Feasibility assessments indicated that only one eligible patient refused randomization and, of patients who attended at least one session, the median number of sessions was six for the BA group and eight for the TAU group. Of three postbaseline monthly assessments, 71.3% (171/240) were successfully obtained. On average, patients in the BA condition completed homework assignments 83.9% of the time. Treatment fidelity ratings indicated that substantially more BA techniques were delivered in the BA group compared to the TAU group (d = 2.11). Measures of BA mechanisms improved significantly over time and these changes were significantly associated with change in depressive symptoms. These results indicate that it is feasible to conduct a randomized study of BA for MDD in a CMHC setting. In addition, the study reconfirmed the potential importance of theory-relevant BA mechanism variables. Following these findings, further investigation into the effectiveness of BA in this setting is needed.
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Affiliation(s)
| | | | | | | | | | - Jena Fisher
- Sharon Hill and Lafayette Hill, Pennsylvania
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Crits-Christoph P, King C, Goldstein E, Connolly Gibbons MB. Use of cognitive techniques is associated with change in positive compensatory skills in the treatment of major depressive disorder in a community mental health setting. Psychother Res 2020; 31:909-920. [PMID: 33377425 DOI: 10.1080/10503307.2020.1866785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
To examine the association between adherence and competence in cognitive therapy (CT) techniques and change in positive compensatory skills and depressive symptoms within a community mental health setting. Adherence ratings were available for 97 individuals receiving CT for major depressive disorder. Assessments of adherence and competence were rated on one early session of CT. Compensatory skills were measured using the Ways of Responding Community Version at baseline and months 1, 2, and 5. Symptom severity was evaluated using the Hamilton Rating Scale for Depression at baseline and months 1, 2, 4, and 5. In mixed effects models, adherence was significantly associated with linear change in positive compensatory skills from baseline to month 5 (F [1, 76] = 8.05, p=.006, r=.31). Competence was also significantly associated with change in positive compensatory skills from baseline to month 5 (F [1, 78] = 5.1, p=.027, r=.25). High adherence was associated with improvements in HAM-D scores from baseline to month 5 (F [1, 78] = 5.1, p=.027, r=.25). Results support the hypothesis that use of CT techniques is associated with change in compensatory skills in a community mental health setting.
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Affiliation(s)
| | - Catherine King
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elena Goldstein
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Flückiger C, Rubel J, Del Re AC, Horvath AO, Wampold BE, Crits-Christoph P, Atzil-Slonim D, Compare A, Falkenström F, Ekeblad A, Errázuriz P, Fisher H, Hoffart A, Huppert JD, Kivity Y, Kumar M, Lutz W, Muran JC, Strunk DR, Tasca GA, Vîslă A, Voderholzer U, Webb CA, Xu H, Zilcha-Mano S, Barber JP. The reciprocal relationship between alliance and early treatment symptoms: A two-stage individual participant data meta-analysis. J Consult Clin Psychol 2020; 88:829-843. [DOI: 10.1037/ccp0000594] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Crits-Christoph P, Rieger A, Gaines A, Gibbons MBC. Trust and respect in the patient-clinician relationship: preliminary development of a new scale. BMC Psychol 2019; 7:91. [PMID: 31888759 PMCID: PMC6937966 DOI: 10.1186/s40359-019-0347-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/28/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Trust and respect may be an important component of client-provider relationships. This study aimed to develop and report preliminary psychometric analyses of a new brief measure to evaluate a patient's level of trust and respect for their clinician. The scale was designed to be applicable in multiple healthcare contexts, with a particular focus on mental healthcare. METHODS Adult patients completed the study survey in an academic outpatient psychiatric clinic waiting room. Classical and Item Response Theory (IRT) analyses were utilized to examine the adequacy of scale items. Validity was examined in relation to the patient-therapist alliance and to willingness to share private information (social media content) with one's clinician. RESULTS Beginning with 10 items, a final 8-item version of the measure was created with an internal consistency reliability of .91. Principal components analysis indicated that the scale was best viewed as capturing one overall dimension. A Graded Response Model IRT model indicated that all items contributed information on the latent dimension, and all item curves were not flat at any region. The correlation of the trust/respect total score with the alliance was .53 when respect-related items were deleted from the alliance score. The trust/respect scale was significantly associated with patient willingness to share social media posts with their clinician but the alliance was not. CONCLUSIONS The brief measure of patient trust and respect towards their clinician was unidimensional, showed good internal consistency, and was not redundant with existing measures of the alliance. The scale has the potential to be used in a wide variety of healthcare settings.
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Affiliation(s)
- Paul Crits-Christoph
- University of Pennsylvania, 3535 Market St (Room 650), Philadelphia, PA, 19104, USA.
| | | | - Averi Gaines
- University of Pennsylvania, 3535 Market St (Room 650), Philadelphia, PA, 19104, USA
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Jennissen S, Connolly Gibbons MB, Crits-Christoph P, Huber J, Nikendei C, Schauenburg H, Dinger U. Insight into conflictual relationship patterns: Development and validation of an observer rating scale. Psychother Res 2019; 30:934-947. [PMID: 31739762 DOI: 10.1080/10503307.2019.1688882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: This study aimed to develop an observer-rated measure of Insight into Conflictual Relationship Patterns (ICR) applicable to audio- or videotapes of psychotherapy sessions and conduct a first psychometric evaluation. Method: We investigated the item properties, principal components, reliability, and validity of the ICR in a naturalistic sample of N = 125 outpatients in psychodynamic psychotherapy. Results: The ICR consists of 12 items that showed adequate item discrimination and item difficulty indices. All items represent one principal component. Using item response theory, discrimination parameters and item characteristic curves revealed that the ability of all items to differentiate patients was adequate to very good. The scale demonstrated good interrater reliability (ICC(3,1) = .76-.93), adequate internal consistency (Cronbach's α = .84), and high retest reliability (r = .91). Regarding validity, the ICR was significantly associated with insight according to the Achievement of Therapeutic Objectives Scale and patient-perceived session depth. Insight at session five predicted a symptomatic increase from session five to session ten. Conclusion: The ICR is an observer-rated measure to assess insight from psychotherapy session recordings that has demonstrated several aspects of reliability and validity. Future studies are needed to clarify the impact of ICR-assessed insight for symptomatic outcome.
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Affiliation(s)
- Simone Jennissen
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Huber
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Henning Schauenburg
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrike Dinger
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Rieger A, Gaines A, Barnett I, Baldassano CF, Connolly Gibbons MB, Crits-Christoph P. Psychiatry Outpatients' Willingness to Share Social Media Posts and Smartphone Data for Research and Clinical Purposes: Survey Study. JMIR Form Res 2019; 3:e14329. [PMID: 31493326 PMCID: PMC6754680 DOI: 10.2196/14329] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/13/2019] [Accepted: 06/09/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Psychiatry research has begun to leverage data collected from patients' social media and smartphone use. However, information regarding the feasibility of utilizing such data in an outpatient setting and the acceptability of such data in research and practice is limited. OBJECTIVE This study aimed at understanding the outpatients' willingness to have information from their social media posts and their smartphones used for clinical or research purposes. METHODS In this survey study, we surveyed patients (N=238) in an outpatient clinic waiting room. Willingness to share social media and passive smartphone data was summarized for the sample as a whole and broken down by sex, age, and race. RESULTS Most patients who had a social media account and who were receiving talk therapy treatment (74.4%, 99/133) indicated that they would be willing to share their social media posts with their therapists. The percentage of patients willing to share passive smartphone data with researchers varied from 40.8% (82/201) to 60.7% (122/201) depending on the parameter, with sleep duration being the parameter with the highest percentage of patients willing to share. A total of 30.4% of patients indicated that media stories of social media privacy breaches made them more hesitant about sharing passive smartphone data with researchers. Sex and race were associated with willingness to share smartphone data, with men and whites being the most willing to share. CONCLUSIONS Our results indicate that most patients in a psychiatric outpatient setting would share social media and passive smartphone data and that further research elucidating patterns of willingness to share passive data is needed.
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Affiliation(s)
- Agnes Rieger
- University of Pennsylvania, Philadelphia, PA, United States
| | - Averi Gaines
- University of Pennsylvania, Philadelphia, PA, United States
| | - Ian Barnett
- University of Pennsylvania, Philadelphia, PA, United States
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Rodgers M, Meisel Z, Wiebe D, Crits-Christoph P, Rhodes KV. Wireless Participant Incentives Using Reloadable Bank Cards to Increase Clinical Trial Retention With Abused Women Drinkers: A Natural Experiment. J Interpers Violence 2019; 34:2774-2796. [PMID: 27503325 PMCID: PMC5589513 DOI: 10.1177/0886260516662849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Retaining participants in longitudinal studies is a unique methodological challenge in many areas of investigation, and specifically for researchers aiming to identify effective interventions for women experiencing intimate partner violence (IPV). Individuals in abusive relationships are often transient and have logistical, confidentiality, and safety concerns that limit future contact. A natural experiment occurred during a large randomized clinical trial enrolling women in abusive relationships who were also heavy drinkers, which allowed for the comparison of two incentive methods to promote longitudinal retention: cash payment versus reloadable wireless bank cards. In all, 600 patients were enrolled in the overall trial, which aimed to incentivize participants using a reloadable bank card system to promote the completion of 11 weekly interactive voice response system (IVRS) phone surveys and 3-, 6-, and 12-month follow-up phone or in person interviews. The first 145 participants were paid with cash as a result of logistical delays in setting up the bank card system. At 12 weeks, participants receiving the bank card incentive completed significantly more IVRS phone surveys, odds ratio (OR) = 2.4, 95% confidence interval (CI) = [0.01, 1.69]. There were no significant differences between the two groups related to satisfaction or safety and/or privacy. The bank card system delivered lower administrative burden for tracking payments for study staff. Based on these and other results, our large medical research university is implementing reloadable bank card as the preferred method of participant incentive payments.
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Affiliation(s)
- Melissa Rodgers
- Perelman School of Medicine, University of Pennsylvania
- College of Education, The University of Texas at Austin
| | | | - Douglas Wiebe
- Perelman School of Medicine, University of Pennsylvania
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Gibbons MBC, Gallop R, Thompson D, Gaines A, Rieger A, Crits-Christoph P. Predictors of treatment attendance in cognitive and dynamic therapies for major depressive disorder delivered in a community mental health setting. J Consult Clin Psychol 2019; 87:745-755. [PMID: 31204838 DOI: 10.1037/ccp0000414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Our goal was to evaluate treatment attendance patterns, including both treatment completion and premature termination from treatment, for 2 evidence-based psychotherapies for major depressive disorder (MDD) delivered in a community mental health setting. We explored rates of premature termination across the course of treatment as well as the factors that predicted and moderated premature termination and treatment completion. METHOD This investigation included 237 patients with MDD who participated in a noninferiority trial comparing short-term dynamic psychotherapy (DT) to cognitive therapy (CT). Patients in both conditions were offered 16 sessions of treatment and had up to 5 months to complete treatment. All patients completed an extensive self-report battery at treatment baseline as well as measures of the therapeutic alliance and opinions about treatment following Session 2. RESULTS Premature termination from both treatments was high with 27% of patients discontinuing treatment very early after only an intake session or a single treatment session. Patients in CT were significantly more likely to terminate treatment prematurely, χ²(3) = 14.35, p = .002. Baseline physical health functioning, subthreshold psychotic symptoms, Session 2 ratings of agreement on tasks, and Session 2 ratings of treatment sensibility all independently predicted premature termination of services. Trauma history significantly moderated very early termination of treatment, χ²(3) = 10.26, p = .017, with patients with high trauma histories more likely to complete DT but terminate prematurely from CT. CONCLUSIONS Very early termination from services was higher in CT compared with DT. Including techniques to improve engagement in both therapies and matching patients to treatment based on predictors/moderators may be effective ways to optimize treatment engagement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Crits-Christoph P, Gallop R, Gaines A, Rieger A, Connolly Gibbons MB. Instrumental variable analyses for causal inference: Application to multilevel analyses of the alliance-outcome relation. Psychother Res 2018; 30:53-67. [PMID: 30451094 DOI: 10.1080/10503307.2018.1544724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: To introduce readers to instrumental variable analyses for causal inferences using as an example a test of the hypothesis that the quality of the therapeutic alliance has a causal role in relation to the outcome of psychotherapy. Method: We used data from a recent non-inferiority trial of cognitive and dynamic therapies for major depressive disorder in a community mental health setting. The data (N = 161) were analyzed using standard approaches as well as a multilevel 2-stage instrumental variables approach that allows for causal interpretations by removing the influence of unmeasured confounds. Results: Instrumental variables were created at the patient and therapist level using baseline patient and therapist variables. These baseline variables predicted the alliance but were otherwise unrelated to treatment outcome other than through their effects on the alliance. Standard multilevel mixed effects analyses revealed statistically significant associations of the alliance with outcome at the therapist level of analysis. The therapist level effect remained statistically significant when using the instrumental variables approach. Conclusion: Our results support the hypothesis that, at least at the therapist level, the alliance plays a causal role in producing better outcomes. Instrumental variable analyses can be a useful tool to supplement standard analyses.
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Affiliation(s)
| | - Robert Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
| | - Averi Gaines
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Agnes Rieger
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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Crits-Christoph P, Wadden S, Gaines A, Rieger A, Gallop R, McKay JR, Gibbons MBC. Symptoms of anhedonia, not depression, predict the outcome of treatment of cocaine dependence. J Subst Abuse Treat 2018; 92:46-50. [PMID: 30032944 PMCID: PMC6502233 DOI: 10.1016/j.jsat.2018.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/18/2018] [Accepted: 06/19/2018] [Indexed: 01/09/2023]
Abstract
The purpose of this paper is to reanalyze data from two studies to determine if anhedonia specifically, rather than depression overall, predicts treatment outcome for patients with cocaine use disorders. Measures of baseline anhedonia symptoms were created using anhedonia items from the Beck Depression Inventory (BDI) to re-examine National Institute on Drug Abuse Cocaine Collaborative Treatment study data (Crits-Christoph et al., 1999) and the contingency management group from the McKay et al. (2010) trial. Baseline anhedonia was used to predict cocaine abstinence rates across the treatment period in both studies. Anhedonia was a significant predictor of cocaine abstinence, even when overall depression scores excluding anhedonia were included in the models. The development of treatments to target individuals with cocaine use disorder who have symptoms of anhedonia has the potential to improve overall outcomes for those with this disorder.
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Affiliation(s)
- Paul Crits-Christoph
- Department of Psychiatry, (1)Perelman School of Medicine, University of Pennsylvania, 3535 Market St., 6th Floor, Philadelphia, PA 19104, United States of America.
| | - Steven Wadden
- Department of Psychiatry, (1)Perelman School of Medicine, University of Pennsylvania, 3535 Market St., 6th Floor, Philadelphia, PA 19104, United States of America
| | - Averi Gaines
- Department of Psychiatry, (1)Perelman School of Medicine, University of Pennsylvania, 3535 Market St., 6th Floor, Philadelphia, PA 19104, United States of America
| | - Agnes Rieger
- Department of Psychiatry, (1)Perelman School of Medicine, University of Pennsylvania, 3535 Market St., 6th Floor, Philadelphia, PA 19104, United States of America
| | - Robert Gallop
- Department of Mathematics, West Chester University, 25 University Avenue, Room 180, West Chester, PA 19383, United States of America
| | - James R McKay
- Department of Psychiatry, (1)Perelman School of Medicine, University of Pennsylvania, 3535 Market St., 6th Floor, Philadelphia, PA 19104, United States of America
| | - Mary Beth Connolly Gibbons
- Department of Psychiatry, (1)Perelman School of Medicine, University of Pennsylvania, 3535 Market St., 6th Floor, Philadelphia, PA 19104, United States of America
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Dichter ME, Thomas KA, Crits-Christoph P, Ogden SN, Rhodes KV. Coercive Control in Intimate Partner Violence: Relationship with Women's Experience of Violence, Use of Violence, and Danger. Psychol Violence 2018; 8:596-604. [PMID: 30555730 PMCID: PMC6291212 DOI: 10.1037/vio0000158] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE The objective of this study was to better understand the experience of coercive control as a type of IPV by examining associations between coercive control and women's experiences of particular forms of violence, use of violence, and risk of future violence. METHOD As part of a larger research study, data were collected from 553 women patients at two hospital emergency departments who had experienced recent IPV and unhealthy drinking. Baseline assessments, including measures of coercive control, danger, and experience and use of psychological, physical, and sexual forms of IPV in the prior three months were analyzed. RESULTS Women experiencing coercive control reported higher frequency of each form of IPV, and higher levels of danger, compared to women IPV survivors who were not experiencing coercive control. There was no statistically significant association between experience of coercive control and women's use of psychological or sexual IPV; women who experienced coercive control were more likely to report using physical IPV than women who were not experiencing coercive control. CONCLUSIONS Findings contribute to knowledge on the relationship between coercive control and specific forms of violence against intimate partners. A primary contribution is the identification that women who experience coercive control may also use violence, indicating that a woman's use of violence does not necessarily mean that she is not also experiencing severe and dangerous violence as well as coercive control. In fact, experience of coercive control may increase victims' use of physical violence as a survival strategy.
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Affiliation(s)
- Melissa E Dichter
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania
| | | | - Paul Crits-Christoph
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Shannon N Ogden
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania
| | - Karin V Rhodes
- Northwell Health Solutions, Office of Population Health Management, Hofstra Northwell Medical School
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Crits-Christoph P, Gallop R, Noll E, Rothbard A, Diehl CK, Connolly Gibbons MB, Gross R, Rhodes KV. Impact of a medical home model on costs and utilization among comorbid HIV-positive Medicaid patients. Am J Manag Care 2018; 24:368-375. [PMID: 30130029 PMCID: PMC6290667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The Pennsylvania Chronic Care Initiative (CCI) was a statewide patient-centered medical home (PCMH) initiative implemented from 2008 to 2011. This study examined whether the CCI affected utilization and costs for HIV-positive Medicaid patients with both medical and behavioral health comorbidities. STUDY DESIGN Nonrandomized comparison of 302 HIV-positive Medicaid patients treated in 137 CCI practices and 2577 HIV-positive Medicaid patients treated elsewhere. METHODS All patients had chronic medical conditions (diabetes, chronic obstructive pulmonary disease, asthma, or congestive heart failure) and a psychiatric and/or substance use disorder. Analyses used Medicaid claims data to examine changes in total per patient costs per month from 1 year prior to 1 year following an index episode. Propensity score weighting was used to adjust for potential sample differences. Secondary outcomes included costs and utilization of emergency department, inpatient, and outpatient/pharmacy services. RESULTS We identified an average total cost savings of $214.10 per patient per month (P = .002) for the CCI group relative to the non-CCI group. This was a function of decreased inpatient medical (-$415.69; P = .007) and outpatient substance abuse treatment (-$4.86; P = .001) costs, but increased non-HIV pharmacy costs ($158.43; P = .001). Utilization for the CCI group, relative to the non-CCI group, was correspondingly decreased for inpatient medical services (odds ratio [OR], 0.619; P = .002) and inpatient services overall (OR, 0.404; P = .001), but that group had greater numbers of outpatient medical service claims when they occurred (11.7%; P = .003) and increased non-HIV pharmacy claims (9.7%; P = .001). CONCLUSIONS There was increased outpatient service utilization, yet relative cost savings, for HIV-positive Medicaid patients with medical and behavioral health comorbidities who were treated in PCMHs.
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Affiliation(s)
- Paul Crits-Christoph
- 3535 Market St, Rm 650, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104.
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Diehl C, Yin S, Markell H, Gallop R, Gibbons MBC, Crits-Christoph P. The Measurement of Cognitive Schemas: Validation of the Psychological Distance Scaling Task in a Community Mental Health Sample. Int J Cogn Ther 2017; 10:17-33. [PMID: 29250215 DOI: 10.1521/ijct_2016_09_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective The purpose of this study was to examine the validity of the Psychological Distance Scaling Task (PDST), a measure of cognitive schema organization, in a community mental health setting. We also compared validity among African Americans and Caucasians. Method In order to accommodate participants with low education levels, 26 out of 80 PDST word stimuli were replaced with similar words at a lower reading level. A sample of 466 (42% African American; 50% Caucasian; 8% other) community patients with major depressive disorder completed the PDST and a variety of depressive symptom measures. Results The modified PDST demonstrated acceptable validity within all subscales. Validity coefficients resembled those reported in prior studies and were similar within minority and non-minority subsamples. Conclusions The modified PDST appears to be a valid measure of schema organization in a low-income, racially diverse population seeking treatment for depression at community clinics.
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Affiliation(s)
- Caroline Diehl
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Seohyun Yin
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Hannah Markell
- Department of Psychology, George Mason University, Fairfax, VA
| | - Robert Gallop
- Department of Mathematics, West Chester University, West Chester, PA
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Crits-Christoph P, Gallop R, Diehl CK, Yin S, Gibbons MBC. Mechanisms of change in cognitive therapy for major depressive disorder in the community mental health setting. J Consult Clin Psychol 2017; 85:550-561. [PMID: 28406648 DOI: 10.1037/ccp0000198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study examined the relation of change in theory-relevant cognitive variables to depressive symptom change over the course of cognitive therapy, as well as the specificity of change mechanisms to cognitive therapy as compared with dynamic therapy. METHOD There were 237 adult outpatients who were randomized to either cognitive (n = 119) or dynamic (n = 118) therapy for major depressive disorder in a community mental health setting. Assessments of compensatory skills (Ways of Responding Community Version and Self-Report Version), dysfunctional attitudes (Dysfunctional Attitudes Scale), and depressogenic schemas (Psychological Distance Scaling Task) were obtained at baseline and months 1, 2, and 5 following baseline. Primary outcome was measured using the Hamilton Rating Scale for Depression. RESULTS Across both therapy conditions, change in all 3 cognitive domains was associated with concurrent change in depressive symptoms. After controlling for other cognitive variables, increased interconnectedness of the positive achievement-related schema was significantly associated with concurrent symptom change in cognitive (rp = .26, p < .001) but not dynamic therapy (rp = .08, p = .29). Increases in positive compensatory skills were associated with subsequent change in depressive symptoms in cognitive therapy (rp = -.36, p = .003), but not in dynamic therapy (rp = .11, p = .386). CONCLUSIONS Results provide support for the compensatory skills model of cognitive therapy (CT) within a community mental health setting. Additional research is necessary to understand other possible mechanisms of change in CT in the community setting. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Seohyun Yin
- Department of Psychiatry, University of Pennsylvania
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Stirman SW, Pontoski K, Creed T, Xhezo R, Evans AC, Beck AT, Crits-Christoph P. A Non-randomized Comparison of Strategies for Consultation in a Community-Academic Training Program to Implement an Evidence-Based Psychotherapy. Adm Policy Ment Health 2017; 44:55-66. [PMID: 26577646 PMCID: PMC5293547 DOI: 10.1007/s10488-015-0700-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite the central role of training and consultation in the implementation of evidence-based psychological interventions (EBPIs), comprehensive reviews of research on training have highlighted serious gaps in knowledge regarding best practices. Consultation after initial didactic training appears to be of critical importance, but there has been very little research to determine optimal consultation format or interventions. This observational study compared two consultation formats that included review of session audio and feedback in the context of a program to train clinicians (n = 85) in community mental health clinics to deliver cognitive therapy (CT). A "gold standard" condition in which clinicians received individual feedback after expert consultants reviewed full sessions was compared to a group consultation format in which short segments of session audio were reviewed by a group of clinicians and an expert consultant. After adjusting for potential baseline differences between individuals in the two consultation conditions, few differences were found in terms of successful completion of the consultation phase or in terms of competence in CT at the end of consultation or after a 2 year follow-up. However, analyses did not support hypotheses regarding non-inferiority of the group consultation condition. While both groups largely maintained competence, clinicians in the group consultation condition demonstrated increases in competence over the follow-up period, while a sub-group of those in the individual condition experienced decreases. These findings, if replicated, have important implications for EBP implementation programs, as they suggest that observation and feedback is feasible in community mental health setting, and that employing this method in a group format is an effective and efficient consultation strategy that may enhance the implementation and sustainability of evidence-based psychotherapies.
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Affiliation(s)
- Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD and Department of Psychiatry and Behavioral Sciences, VA Palo Alto Healthcare System and Stanford University, 795 Willow Road (NC-PTSD), Menlo Park, CA, 94025, USA.
| | - Kristin Pontoski
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA
| | - Torrey Creed
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA
| | - Regina Xhezo
- Department of Behavioral Health and Intellectual DisAbility Services, 801 Market Street, 7th Floor, Philadelphia, PA, 19107, USA
| | - Arthur C Evans
- Department of Behavioral Health and Intellectual DisAbility Services, 801 Market Street, 7th Floor, Philadelphia, PA, 19107, USA
| | - Aaron T Beck
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA
| | - Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA
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Abstract
This investigation examined the relative effectiveness of positive imagery and active-involvement imagery in the systematic desensitization treatment of phobias. Immediately after imagining hierarchy phobic scenes, clients in the positive imagery group ( N = 9) imagined pleasant, relaxing scenes while clients in the active-involvement imagery group ( N = 10) imagined themselves attempting to cope directly with the phobic stimulus and behaving in a relaxed and competent manner. At the end of treatment both groups showed substantial and equal improvement in the severity of their specific fear compared to a waiting list control group ( N = 6). The positive imagery group showed greater reductions in general distress and obsessive-compulsive symptomatology. Follow-up assessment conducted one year after the termination of therapy revealed that the improvement was maintained in both treatment groups. On within treatment measures, the positive imagery group showed greater reductions in forehead electromygraphic activity during phobic scenes after repeated presentations of the phobic scene-positive scene sequence and the active-involvement imagery group showed greater reductions in self-report of fear across repeated presentations of their imagery sequence. The clinical usefulness of the imagery treatments and their theoretical foundations are discussed.
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Rhodes KV, Basseyn S, Gallop R, Noll E, Rothbard A, Crits-Christoph P. Pennsylvania's Medical Home Initiative: Reductions in Healthcare Utilization and Cost Among Medicaid Patients with Medicaland Psychiatric Comorbidities. J Gen Intern Med 2016; 31:1373-1381. [PMID: 27353455 PMCID: PMC5071276 DOI: 10.1007/s11606-016-3734-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 12/15/2015] [Accepted: 04/29/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Chronic Care Initiative (CCI) was a large state-wide patient-centered medical home (PCMH) initiative in Pennsylvania in place from 2008-2011. OBJECTIVE Determine whether the CCI impacted the utilization and costs for Medicaid patients with chronic medical conditions and comorbid psychiatric or substance use disorders. DESIGN Analysis of Medicaid claims using difference-in-difference regression analyses to compare changes in utilization and costs for patients treated at CCI practices to propensity score-matched patients treated at comparison non-CCI practices. SETTING Ninety-six CCI practices in Pennsylvania and 60 non-CCI practices during the same time period. PARTICIPANTS A total of 11,105 comorbid Medicaid patients treated in CCI practices and an equal number of propensity-matched comparison patients treated in non-CCI practices. MEASUREMENTS Changes in total per-patient costs from 1 year prior to 1 year following an index episode period. Secondary outcomes included utilization and costs for emergency department (ED), inpatient, and outpatient services. RESULTS The CCI group experienced an average adjusted total cost savings of $4145.28 per patient per year (P = 0.023) for the CCI relative to the non-CCI group. This was largely driven by a $3521.15 savings (P = 0.046) in inpatient medical costs, in addition to relative savings in outpatient psychiatric ($21.54, P < 0.001) and substance abuse service costs ($16.42, P = 0.013), compared to the non-CCI group. The CCI group, related to the non-CCI group, had decreases in expected mean counts of ED visits (for those who had any) and psychiatric hospitalizations of 15.6 (95 % CI: -21, -9) and 40.7 (95 % CI: -57, -18) percentage points respectively. LIMITATIONS We do not measure quality of care and cannot make conclusions about the overall cost-effectiveness or long-term effects of the CCI. CONCLUSIONS The CCI was associated with substantial cost savings, attributable primarily to reduced inpatient costs, among a high-risk group of Medicaid patients, who may disproportionally benefit from care management in patient-centered medical homes.
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Affiliation(s)
- Karin V Rhodes
- Office of Population Health Management, Hofstra Northwell Medical School, Emergency Medicine Service Line & Northwell Health Solutions, 200 Community Drive, Great Neck, NY, 11021, USA.
| | - Simon Basseyn
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- The Wharton School of Business, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gallop
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- West Chester University, West Chester, PA, USA
| | - Elizabeth Noll
- University of Pennsylvania School of Social Policy and Practice, Philadelphia, PA, USA
| | - Aileen Rothbard
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania School of Social Policy and Practice, Philadelphia, PA, USA
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Yin S, Connolly Gibbons MB, Diehl C, Gallop R, Crits-Christoph P. A self-report version of the Ways of Responding: Reliability and validity in a clinical sample. Psychother Res 2016; 28:581-592. [PMID: 27653284 DOI: 10.1080/10503307.2016.1233367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The Ways of Responding (WOR) instrument measures compensatory skills, a central construct in some theories of the mechanism of cognitive therapy for depression. However, the instrument is time-consuming and expensive to use in community settings, because it requires trained independent judges to rate subjects' open-ended written responses to depressogenic scenarios. The present study evaluated the reliability and validity of a self-report version of the WOR (WOR-SR) in a community mental health sample with depressive symptoms (N = 467). METHOD Subjects completed the WOR-SR, a modified version of the original WOR, and other measures of depressive symptoms, dysfunctional cognitions, functioning, quality of life, and interpersonal problems at multiple time points. RESULTS An exploratory factor analysis confirmed the two-factor structure of the WOR-SR. The positive and negative subscales both demonstrated excellent internal consistency (Cronbach's alphas = .91) and moderate convergent validity with other measures. CONCLUSION The WOR-SR is a reliable and valid measure of compensatory skills in patients receiving treatment for depression at community mental health centers.
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Affiliation(s)
- Seohyun Yin
- a Department of Psychiatry , University of Pennsylvania , Philadelphia , PA , USA
| | | | - Caroline Diehl
- a Department of Psychiatry , University of Pennsylvania , Philadelphia , PA , USA
| | - Robert Gallop
- b Department of Mathematics , West Chester University , West Chester , PA , USA
| | - Paul Crits-Christoph
- a Department of Psychiatry , University of Pennsylvania , Philadelphia , PA , USA
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Gibbons MBC, Gallop R, Thompson D, Luther D, Crits-Christoph K, Jacobs J, Yin S, Crits-Christoph P. Comparative Effectiveness of Cognitive Therapy and Dynamic Psychotherapy for Major Depressive Disorder in a Community Mental Health Setting: A Randomized Clinical Noninferiority Trial. JAMA Psychiatry 2016; 73:904-11. [PMID: 27487573 PMCID: PMC5627972 DOI: 10.1001/jamapsychiatry.2016.1720] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Dynamic psychotherapy (DT) is widely practiced in the community, but few trials have established its effectiveness for specific mental health disorders relative to control conditions or other evidence-based psychotherapies. OBJECTIVE To determine whether DT is not inferior to cognitive therapy (CT) in the treatment of major depressive disorder (MDD) in a community mental health setting. DESIGN, SETTING, AND PARTICIPANTS From October 28, 2010, to July 2, 2014, outpatients with MDD were randomized to treatment delivered by trained therapists. Twenty therapists employed at a community mental health center in Pennsylvania were trained by experts in CT or DT. A total of 237 adult outpatients with MDD seeking services at this site were randomized to 16 sessions of DT or CT delivered across 5 months. Final assessment was completed on December 9, 2014, and data were analyzed from December 10, 2014, to January 14, 2016. INTERVENTIONS Short-term DT or CT. MAIN OUTCOMES AND MEASURES Expert blind evaluations with the 17-item Hamilton Rating Scale for Depression. RESULTS Among the 237 patients (59 men [24.9%]; 178 women [75.1%]; mean [SD] age, 36.2 [12.1] years) treated by 20 therapists (19 women and 1 man; mean [SD] age, 40.0 [14.6] years), 118 were randomized to DT and 119 to CT. A mean (SD) difference between treatments was found in the change on the Hamilton Rating Scale for Depression of 0.86 (7.73) scale points (95% CI, -0.70 to 2.42; Cohen d, 0.11), indicating that DT was statistically not inferior to CT. A statistically significant main effect was found for time (F1,198 = 75.92; P = .001). No statistically significant differences were found between treatments on patient ratings of treatment credibility. Dynamic psychotherapy and CT were discriminated from each other on competence in supportive techniques (t120 = 2.48; P = .02), competence in expressive techniques (t120 = 4.78; P = .001), adherence to CT techniques (t115 = -7.07; P = .001), and competence in CT (t115 = -7.07; P = .001). CONCLUSIONS AND RELEVANCE This study suggests that DT is not inferior to CT on change in depression for the treatment of MDD in a community mental health setting. The 95% CI suggests that the effects of DT are equivalent to those of CT. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01207271.
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Affiliation(s)
- Mary Beth Connolly Gibbons
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gallop
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Kathryn Crits-Christoph
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julie Jacobs
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Seohyun Yin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Crits-Christoph
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Crits-Christoph P, Markell HM, Gibbons MBC, Gallop R, Lundy C, Stringer M, Gastfriend DR. A Naturalistic Evaluation of Extended-Release Naltrexone in Clinical Practice in Missouri. J Subst Abuse Treat 2016; 70:50-57. [PMID: 27692188 DOI: 10.1016/j.jsat.2016.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/15/2016] [Accepted: 07/29/2016] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to compare the naturalistic outcomes of individuals with alcohol or opioid use problems who were treated with extended-release naltrexone (XR-NTX) to those treated with psychosocial treatment only and also to those treated with other medication-assisted therapies in Missouri during 2010 to 2011. We analyzed intake and discharge data collected as part of SAMHSA's Treatment Episode Data Set assessments. Patients who received XR-NTX during their treatment episode were compared, for those reporting alcohol (but not opioids) as their problem (N=21,137), to those who received oral naltrexone, acamprosate, and psychosocial treatment only, and for those who reported opioids as a problem (N=8996), to those receiving oral naltrexone, buprenorphine/naloxone, and psychosocial treatment only. Group differences were adjusted using propensity score weighting, with propensity scores derived from 18 intake variables. For the alcohol sample, patients who received XR-NTX vs. the oral naltrexone group had superior composite outcomes on a measure combining abstinence, self-help participation, employment, and arrests. For the opioid sample, XR-NTX was found to have significantly better outcomes than oral naltrexone on the composite outcome measure. For both the alcohol and opioid samples, the group that received XR-NTX stayed in treatment longer vs. psychosocial treatment only. In the opioid sample, those receiving buprenorphine/naloxone remained in treatment longer than those receiving XR-NTX.
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Affiliation(s)
- Paul Crits-Christoph
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Hannah M Markell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Christie Lundy
- Missouri Department of Mental Health, Jefferson City, MO
| | - Mark Stringer
- Missouri Department of Mental Health, Jefferson City, MO
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Rodgers MA, Grisso JA, Crits-Christoph P, Rhodes KV. No Quick Fixes: A Mixed Methods Feasibility Study of an Urban Community Health Worker Outreach Program for Intimate Partner Violence. Violence Against Women 2016; 23:287-308. [PMID: 27075666 DOI: 10.1177/1077801216640383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Community health workers (CHWs) provide peer support in diverse health care settings, but few studies have evaluated CHW interventions for intimate partner violence (IPV). We assessed the feasibility, acceptability, and safety of CHW outreach in four urban community health clinics and characterized the experiences and barriers to providing safe and effective services for women experiencing IPV. CHWs successfully enrolled and engaged IPV victims, who indicated satisfaction and increased safety with program participation. However, complex psychosocial barriers prevented many from achieving safety and security. More work is needed to assess the impact of well-integrated IPV-trained CHWs in primary care medical homes.
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Affiliation(s)
| | | | | | - Karin V Rhodes
- 3 Northwell Health System at the Hofstra School of Medicine, Hempstead, NY, USA
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Wiltsey Stirman S, Gutner CA, Crits-Christoph P, Edmunds J, Evans AC, Beidas RS. Relationships between clinician-level attributes and fidelity-consistent and fidelity-inconsistent modifications to an evidence-based psychotherapy. Implement Sci 2015; 10:115. [PMID: 26268633 PMCID: PMC4534152 DOI: 10.1186/s13012-015-0308-z] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinicians often modify evidence-based psychotherapies (EBPs) when delivering them in routine care settings. There has been little study of factors associated with or implications of modifications to EBP protocols. This paper differentiates between fidelity-consistent and fidelity-inconsistent modifications and it examines the potential influence of two clinician characteristics, training outcomes, and attitudes toward EBPs on fidelity-consistent and fidelity-inconsistent modifications of cognitive behavioral therapy in a sample of clinicians who had been trained to deliver these treatments for children or adults. METHODS Survey and coded interview data collected 2 years after completion of training programs in cognitive behavioral therapy were used to examine associations between successful or unsuccessful completion of training, clinician attitudes, and modifications. Modifications endorsed by clinicians were categorized as fidelity-consistent or fidelity-inconsistent and entered as outcomes into separate regression models, with training success and attitudes entered as independent variables. RESULTS Successful completion of a training program was associated with subsequent fidelity-inconsistent modifications but not fidelity-consistent modifications. Therapists who reported greater openness to using EBPs prior to training reported more fidelity-consistent modifications at follow-up, and those who reported greater willingness to adopt EBPs if they found them appealing were more likely to make fidelity-inconsistent modifications. CONCLUSIONS Implications of these findings for training, implementation, EBP sustainment, and future studies are discussed. Research on contextual and protocol-related factors that may impact decisions to modify EBPs will be an important future direction of study to complement to this research.
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Affiliation(s)
- Shannon Wiltsey Stirman
- National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine, Department of Psychiatry, 150 S. Huntington Ave (116B3), Boston, MA, 02130, USA.
| | - Cassidy A Gutner
- National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine, Department of Psychiatry, 150 S. Huntington Ave (116B3), Boston, MA, 02130, USA.
| | - Paul Crits-Christoph
- Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, Philadelphia, USA.
| | - Julie Edmunds
- Department of Psychiatry, Harvard University Medical School, Boston, MA, USA.
| | - Arthur C Evans
- Philadelphia Department of Behavioral Health and Developmental disAbility Services, 3535 Market Street, Philadelphia, USA.
| | - Rinad S Beidas
- Center for Mental Health Policy and Services Research, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, USA.
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Rhodes KV, Rodgers M, Sommers M, Hanlon A, Chittams J, Doyle A, Datner E, Crits-Christoph P. Brief Motivational Intervention for Intimate Partner Violence and Heavy Drinking in the Emergency Department: A Randomized Clinical Trial. JAMA 2015; 314:466-477. [PMID: 26241598 PMCID: PMC5637389 DOI: 10.1001/jama.2015.8369] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Intimate partner violence (IPV) and heavy drinking are co-occurring public health problems, but integrated brief interventions for these conditions have not been tested. OBJECTIVE To determine whether a brief motivational intervention provided at the time of an emergency department (ED) visit reduces IPV and heavy drinking. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial conducted at 2 US academic urban EDs between January 2011 and December 2014 to assess the effectiveness of a motivational intervention for IPV-involved female ED patients (ages: 18-64 years; N = 600) who exceeded sex-specific safe drinking limits. All received social service referrals; 2:2:1 to brief intervention (n = 242), assessed control (n = 237), or no-contact control (n = 121). INTERVENTIONS A 20- to 30-minute manual-guided motivational intervention (recorded and monitored for fidelity) delivered by master's-level therapists with a follow-up telephone booster. The assessed control group received the same number of assessments as the brief intervention group; the no-contact control group was assessed only once at 3 months. MAIN OUTCOMES AND MEASURES Incidents of heavy drinking and experiencing IPV measured over prespecified, 12 weekly assessments using an interactive voice response system. RESULTS Of 600 participants, 80% were black women with a mean age of 32 years. Retention was 89% for 2 or more interactive voice response system calls. Seventy-eight percent of women completed the 3-month interview, 79% at 6 months, and 71% at 12 months. During the 12-week period following the brief motivational intervention, there were no significant differences between the intervention group and the assessed control group on weekly assessments for experiencing IPV (odds ratio [OR], 1.02; 95% CI, 0.98-1.06) or heavy drinking (OR, 0.99; 95% CI, 0.96-1.03). From baseline to 12 weeks, the number of women with any IPV in the past week decreased from 57% (134 of 237) in the intervention group to 43% (83 of 194) and from 63% (145 of 231) in the assessed control group to 41% (77 of 187) (absolute difference of 8%). From baseline to 12 weeks, the number of women with past week heavy drinking decreased from 51% (120 of 236) in the intervention group to 43% (83 of 194) and from 46% (107 of 231) in the assessed control group to 41% (77 of 187) (absolute difference of 3%). At 12 months, 43% (71 of 165) of the intervention group and 47% (78 of 165) of the assessed control group reported no IPV during the previous 3 months and 19% (29 of 152) of the intervention group and 24% (37 of 153) of the control group had reduced their alcohol consumption to sex-specific National Institute on Alcohol Abuse and Alcoholism safe drinking levels. CONCLUSIONS AND RELEVANCE For women experiencing IPV and heavy drinking, the use of a brief motivational intervention in the ED compared with assessed and no-contact controls did not significantly reduce the days of heavy drinking or incidents of IPV. These findings do not support a brief motivational intervention in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifer: NCT01207258.
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Affiliation(s)
- Karin V Rhodes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Melissa Rodgers
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Jesse Chittams
- School of Nursing, University of Pennsylvania, Philadelphia
| | - Andrea Doyle
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Elizabeth Datner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Philadelphia VA Medical Center, Philadelphia, Pennsylvania
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Leichsenring F, Ablon S, Barber JP, Beutel M, Gibbons MBC, Crits-Christoph P, Klein S, Leweke F, Steinert C, Wiltink J, Salzer S. Developing a prototype for short-term psychodynamic (supportive-expressive) therapy: An empirical study with the psychotherapy process Q-set. Psychother Res 2015. [PMID: 26218673 DOI: 10.1080/10503307.2015.1051160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE A Psychotherapy Process Q-set (PQS) prototype characteristic of short-term psychodynamic therapy (STPP) does not yet exist. METHOD Experts in supportive-expressive (SE) therapy used the 100-Item PQS questionnaire to rate an ideal short-term SE therapy. RESULTS Agreement between raters was high (Cronbach's alpha = 0.94). The prototype for SE therapy showed a significant correlation with the psychoanalytic prototype, but with 28% of variance explained, the majority of variance of the former was not explained by the latter or vice versa. Furthermore, the SE prototype showed significant correlations with the cognitive-behavioral prototype and the prototype of interpersonal therapy by Ablon and Jones (r = 0.69, 0.43). CONCLUSIONS We recommend using the PQS prototype presented here for future process research on STPP.
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Affiliation(s)
- Falk Leichsenring
- a Department of Psychosomatics and Psychotherapy , Justus-Liebig-University Giessen , Giessen , Germany
| | - Stuart Ablon
- b Department of Psychiatry , Massachusetts General Hospital , Newton , MA , USA
| | - Jacques P Barber
- c Derner Institute of Advanced Psychological Studies , Adelphi University , Garden City , NY , USA
| | - Manfred Beutel
- d Clinic of Psychosomatic Medicine and Psychotherapy , University Medical Center, Johannes Gutenberg University Mainz , Mainz , Germany
| | | | - Paul Crits-Christoph
- e Department of Psychiatry , University of Pennsylvania , Philadelphia , PA , USA
| | - Susanne Klein
- a Department of Psychosomatics and Psychotherapy , Justus-Liebig-University Giessen , Giessen , Germany
| | - Frank Leweke
- a Department of Psychosomatics and Psychotherapy , Justus-Liebig-University Giessen , Giessen , Germany
| | - Christiane Steinert
- a Department of Psychosomatics and Psychotherapy , Justus-Liebig-University Giessen , Giessen , Germany
| | - Jörg Wiltink
- d Clinic of Psychosomatic Medicine and Psychotherapy , University Medical Center, Johannes Gutenberg University Mainz , Mainz , Germany
| | - Simone Salzer
- f Department of Psychosomatic Medicine and Psychotherapy , Georg-August-University Goettingen , Goettingen , Germany
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Stirman SW, Matza A, Gamarra J, Toder K, Xhezo R, Evans AC, Hurford M, Beck AT, Crits-Christoph P, Creed T. System-Level Influences on the Sustainability of a Cognitive Therapy Program in a Community Behavioral Health Network. Psychiatr Serv 2015; 66:734-42. [PMID: 25828878 PMCID: PMC4490058 DOI: 10.1176/appi.ps.201400147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to examine influences on the sustainability of a program to implement an evidence-based psychotherapy in a mental health system. METHODS Interviews with program administrators, training consultants, agency administrators, and supervisors (N=24), along with summaries of program evaluation data and program documentation, were analyzed with a directed content-analytic approach. RESULTS Findings suggested a number of interconnected and interacting influences on sustainability, including alignment with emerging sociopolitical influences and system and organizational priorities; program-level adaptation and evolution; intervention flexibility; strong communication, collaboration, planning, and support; and perceived benefit. These individual factors appeared to mutually influence one another and contribute to the degree of program sustainability achieved at the system level. Although most influences were positive, financial planning and support emerged as potentially both facilitator and barrier, and evaluation of benefits at the patient level remained a challenge. CONCLUSIONS Several factors appeared to contribute to the sustainability of a psychosocial intervention in a large urban mental health system and warrant further investigation. Understanding interconnections between multiple individual facilitators and barriers appears critical to advancing understanding of sustainability in dynamic systems and adds to emerging recommendations for other implementation efforts. In particular, implications of the findings include the importance of implementation strategies, such as long-term planning, coalition building, clarifying roles and expectations, planned adaptation, evaluation, diversification of financing strategies, and incentivizing implementation.
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Affiliation(s)
- Shannon Wiltsey Stirman
- Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia
| | - Alexis Matza
- Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia
| | - Jennifer Gamarra
- Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia
| | - Katherine Toder
- Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia
| | - Regina Xhezo
- Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia
| | - Arthur C Evans
- Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia
| | - Matthew Hurford
- Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia
| | - Aaron T Beck
- Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia
| | - Paul Crits-Christoph
- Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia
| | - Torrey Creed
- Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia
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Connolly Gibbons MB, Kurtz JE, Thompson DL, Mack RA, Lee JK, Rothbard A, Eisen SV, Gallop R, Crits-Christoph P. The effectiveness of clinician feedback in the treatment of depression in the community mental health system. J Consult Clin Psychol 2015; 83:748-59. [PMID: 26052874 DOI: 10.1037/a0039302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We describe the development and evaluation of a clinician feedback intervention for use in community mental health settings. The Community Clinician Feedback System (CCFS) was developed in collaboration with a community partner to meet the needs of providers working in such community settings. METHOD The CCFS consists of weekly performance feedback to clinicians, as well as a clinical feedback report that assists clinicians with patients who are not progressing as expected. Patients in the randomized sample (N = 100) were predominantly female African Americans, with a mean age of 39 years. RESULTS Satisfaction ratings of the CCFS indicate that the system was widely accepted by clinicians and patients. A hierarchical linear models (HLM) analysis comparing rates of change across conditions controlling for baseline gender, age, and racial group indicated a moderate effect in favor of the feedback condition for symptom improvement, t(94) = 2.41, p = .017, d = .50. Thirty-six percent of feedback patients compared with only 13% of patients in the no-feedback condition demonstrated clinically significant change across treatment, χ2(1) = 6.13, p = .013. CONCLUSIONS These results indicate that our CCFS is acceptable to providers and patients of mental health services and has the potential to improve the effectiveness of services for clinically meaningful depression in the community mental health setting.
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Affiliation(s)
| | | | | | - Rachel A Mack
- Department of Psychiatry, University of Pennsylvania
| | | | | | - Susan V Eisen
- Department of Health Policy and Management, Boston University
| | - Robert Gallop
- Department of Psychiatry, University of Pennsylvania
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Abstract
Count reponses with structural zeros are very common in medical and psychosocial research, especially in alcohol and HIV research, and the zero-inflated poisson (ZIP) and zero-inflated negative binomial (ZINB) models are widely used for modeling such outcomes. However, as alcohol drinking outcomes such as days of drinkings are counts within a given period, their distributions are bounded above by an upper limit (total days in the period) and thus inherently follow a binomial or zero-inflated binomial (ZIB) distribution, rather than a Poisson or zero-inflated Poisson (ZIP) distribution, in the presence of structural zeros. In this paper, we develop a new semiparametric approach for modeling zero-inflated binomial (ZIB)-like count responses for cross-sectional as well as longitudinal data. We illustrate this approach with both simulated and real study data.
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Affiliation(s)
- H He
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY 14642, USA
| | - W J Wang
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY 14642, USA
| | - J Hu
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY 14642, USA ; College of Basic Science and Information Engineering, Yunnan Agricultural University, Kunming, Yunnan, China, 650201
| | - R Gallop
- Department of Mathematics and Applied Statistics, West Chester University, West Chester, PA 19383, USA
| | - P Crits-Christoph
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Y L Xia
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY 14642, USA
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Gibbons MBC, Thompson SM, Mack RA, Lee JK, Crits-Christoph P. The relation of baseline skills to psychotherapy outcome across diverse psychotherapies. J Clin Psychol 2015; 71:491-9. [PMID: 25779087 DOI: 10.1002/jclp.22165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We explored whether patients with varied levels of baseline deficits in compensatory skills and self-understanding had different outcomes across cognitive and dynamic therapies. METHOD The assessment battery was administered at intake and termination (N = 97; 66% female, 81% Caucasian). We conducted regression analyses predicting symptom change from baseline levels of self-understanding and compensatory skills. We also evaluated the interaction between baseline skill levels and treatment condition in the prediction of psychotherapy outcome. RESULTS There was a significant interaction between treatment group and baseline compensatory skills in the prediction of Hamilton Depression Rating Scale (HAMD) symptom change, F(1,76) = 4.59, p = .035. Baseline deficits in compensatory skills were significantly related to symptom change for patients who received cognitive treatment, ηρ = .40, p = .037, while baseline levels of self-understanding were not significantly predictive of treatment outcome in either condition. Baseline skill variables did not predict symptom change as measured by the HAMA. CONCLUSIONS The findings support a capitalization model of cognitive therapy, whereby patients with relative strengths in compensatory skills at baseline have better treatment outcomes.
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Crits-Christoph P, Markell HM, Gallop R, Gibbons MBC, McClure B, Rotrosen J. Predicting outcome of substance abuse treatment in a feedback study: Can recovery curves be improved upon? Psychother Res 2015; 25:694-704. [PMID: 25588189 DOI: 10.1080/10503307.2014.994146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The goal of the study was to evaluate whether enhanced normative feedback recovery curves are needed for treatment of substance use problems. METHOD Patient predictors of outcome were examined using data from four substance abuse treatment clinics. RESULTS Baseline severity of symptoms/functioning, employment, and craving were found to be associated with rate of change in symptoms/functioning. Several other variables were associated with rate of change in alcohol use, although in the opposite direction than found in efficacy trials. CONCLUSIONS The results point to the complexity of designing feedback systems using normative recovery curves for those with substance use problems and highlight the important differences between real-world treatment of those with substance use problems compared to data from efficacy trials.
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Affiliation(s)
- Paul Crits-Christoph
- a Department of Psychiatry , University of Pennsylvania , Philadelphia , PA , USA
| | - Hannah M Markell
- a Department of Psychiatry , University of Pennsylvania , Philadelphia , PA , USA
| | - Robert Gallop
- b Department of Mathematics , West Chester University , West Chester , PA , USA
| | | | - Bridget McClure
- c Joint Clinical Trials Office , Weill Cornell Medical College , New York , NY , USA
| | - John Rotrosen
- d Department of Psychiatry , New York University School of Medicine , New York , NY , USA
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Connolly Gibbons MB, Mack R, Lee J, Gallop R, Thompson D, Burock D, Crits-Christoph P. Comparative effectiveness of cognitive and dynamic therapies for major depressive disorder in a community mental health setting: study protocol for a randomized non-inferiority trial. BMC Psychol 2015; 2:47. [PMID: 25566391 PMCID: PMC4270014 DOI: 10.1186/s40359-014-0047-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 10/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is substantial evidence that cognitive therapy is an effective intervention for the treatment of major depressive disorder. Although dynamic psychotherapies have been widely studied and are commonly practiced worldwide, there are few randomized comparisons of cognitive therapy and dynamic therapy for major depressive disorder. METHODS We are completing data collection on a randomized non-inferiority trial comparing the effectiveness of cognitive therapy and short-term dynamic psychotherapy in the treatment of major depressive disorder in the community mental health setting. Therapists employed in the community setting have been recruited for training in either short-term dynamic psychotherapy or cognitive therapy. Patients seeking services at the community site who meet criteria for major depressive disorder based on a blind independent diagnostic interview are randomized to 16 sessions of treatment. All patients are assessed at baseline and months 1, 2, 4, and 5 utilizing a comprehensive battery. DISCUSSION This study adds to the growing literature evaluating the effectiveness of short-term dynamic psychotherapy for specific diagnostic groups. These results will have implications for the dissemination of effective interventions for major depressive disorder in community mental health settings. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov, a service of the United States National Institute of Health. NIH Identifier: NCT01207271. Registered 21 September 2010.
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Affiliation(s)
- Mary Beth Connolly Gibbons
- Perelman School of Medicine, University of Pennsylvania, 3535 Market St (Room 649), Philadelphia, PA 19104 USA
| | - Rachel Mack
- Perelman School of Medicine, University of Pennsylvania, 3535 Market St (Room 649), Philadelphia, PA 19104 USA
| | - Jacqueline Lee
- Perelman School of Medicine, University of Pennsylvania, 3535 Market St (Room 649), Philadelphia, PA 19104 USA
| | - Robert Gallop
- Perelman School of Medicine, University of Pennsylvania, 3535 Market St (Room 649), Philadelphia, PA 19104 USA
| | | | | | - Paul Crits-Christoph
- Perelman School of Medicine, University of Pennsylvania, 3535 Market St (Room 649), Philadelphia, PA 19104 USA
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Crits-Christoph P, Chambless DL, Markell HM. Moving evidence-based practice forward successfully: commentary on Laska, Gurman, and Wampold. Psychotherapy (Chic) 2014; 51:491-5. [PMID: 25419728 DOI: 10.1037/a0036508] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Laska, Gurman, and Wampold (2014, pp. 467-481) present their common factors (CF) model as an alternative/complement to existing empirically supported treatments. The CF model is largely based on nonrandomized studies and a post hoc interpretation of a lack of differences between psychotherapies in their outcomes. Our view is that the CF model would be advanced through randomized experiments that test the specific components that Laska et al. (2014) hypothesize as necessary and sufficient for change. With some notable exceptions, we agree with many of the points made by Laska et al. (2014) regarding the relevance of the CF perspective to the delivery of psychotherapy in general, but suggest that prospective studies that control for potential confounds are needed to successfully advance the CF model or any other model of psychotherapy.
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Abstract
Summary In psychosocial and behavioral studies count outcomes recording the frequencies of the
occurrence of some health or behavior outcomes (such as the number of unprotected sexual behaviors
during a period of time) often contain a preponderance of zeroes because of the presence of ‘structural
zeroes’ that occur when some subjects are not at risk for the behavior of interest. Unlike random zeroes
(responses that can be greater than zero, but are zero due to sampling variability), structural zeroes are
usually very different, both statistically and clinically. False interpretations of results and study findings may
result if differences in the two types of zeroes are ignored. However, in practice, the status of the structural
zeroes is often not observed and this latent nature complicates the data analysis. In this article, we focus on
one model, the zero-inflated Poisson (ZIP) regression model that is commonly used to address zero-inflated
data. We first give a brief overview of the issues of structural zeroes and the ZIP model. We then given an
illustration of ZIP with data from a study on HIV-risk sexual behaviors among adolescent girls. Sample codes
in SAS and Stata are also included to help perform and explain ZIP analyses.
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Affiliation(s)
- Hua He
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA ; Veterans Integrated Service Network, Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA ; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Wan Tang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Wenjuan Wang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
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He H, Wang W, Crits-Christoph P, Gallop R, Tang W, Chen DG(D, Tu XM. On the implication of structural zeros as independent variables in regression analysis: applications to alcohol research. J Data Sci 2014; 12:439-460. [PMID: 28989340 PMCID: PMC5628625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In alcohol studies, drinking outcomes such as number of days of any alcohol drinking (DAD) over a period of time do not precisely capture the differences among subjects in a study population of interest. For example, the value of 0 on DAD could mean that the subject was continually abstinent from drinking such as lifetime abstainers or the subject was alcoholic, but happened not to use any alcohol during the period of interest. In statistics, zeros of the first kind are called structural zeros, to distinguish them from the sampling zeros of the second type. As the example indicates, the structural and sampling zeros represent two groups of subjects with quite different psychosocial outcomes. In the literature on alcohol use, although many recent studies have begun to explicitly account for the differences between the two types of zeros in modeling drinking variables as a response, none has acknowledged the implications of the different types of zeros when such modeling drinking variables are used as a predictor. This paper serves as the first attempt to tackle the latter issue and illustrate the importance of disentangling the structural and sampling zeros by using simulated as well as real study data.
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Affiliation(s)
- Hua He
- University of Rochester Medical Center
| | | | | | | | - Wan Tang
- University of Rochester Medical Center
| | | | - Xin M. Tu
- University of Rochester Medical Center
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Markell HM, Newman MG, Gallop R, Gibbons MBC, Rickels K, Crits-Christoph P. Combined medication and CBT for generalized anxiety disorder with African American participants: reliability and validity of assessments and preliminary outcomes. Behav Ther 2014; 45:495-506. [PMID: 24912462 PMCID: PMC4260926 DOI: 10.1016/j.beth.2014.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 11/28/2022]
Abstract
Using data from a study of combined cognitive behavioral therapy (CBT) and venlafaxine XR in the treatment of generalized anxiety disorder (GAD), the current article examines the reliability and convergent validity of scales, and preliminary outcomes, for African American compared with European American patients. Internal consistency and short-term stability coefficients for African Americans (n=42) were adequate and similar or higher compared with those found for European Americans (n=164) for standard scales used in GAD treatment research. Correlations among outcome measures among African Americans were in general not significantly different for African Americans compared with European Americans. A subset of patients with DSM-IV-diagnosed GAD (n=24 African Americans; n=52 European Americans) were randomly selected to be offered the option of adding 12 sessions of CBT to venlafaxine XR treatment. Of those offered CBT, 33.3% (n=8) of the African Americans and 32.6% (n=17) of the European Americans accepted and attended at least one CBT treatment session. The outcomes for African Americans receiving combined treatment were not significantly different from European Americans receiving combined treatment on primary or secondary efficacy measures.
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Affiliation(s)
- Hannah M. Markell
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104
| | - Michelle G. Newman
- Department of Psychology, Pennsylvania State University, 111 Moore Building, University Park, PA 16802
| | - Robert Gallop
- Department of Mathematics, West Chester University, 25 University Avenue, West Chester, PA 19383
| | | | - Karl Rickels
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104
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Rhodes KV, Rodgers M, Sommers M, Hanlon A, Crits-Christoph P. The Social Health Intervention Project (SHIP): protocol for a randomized controlled clinical trial assessing the effectiveness of a brief motivational intervention for problem drinking and intimate partner violence in an urban emergency department. BMC Emerg Med 2014; 14:10. [PMID: 24742322 PMCID: PMC4101846 DOI: 10.1186/1471-227x-14-10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/14/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is a strong reciprocal association between two highly prevalent public health problems: intimate partner violence and heavy drinking, both of which remain major sources of morbidity and mortality. Brief interventions in the Emergency Department setting have been found to be effective in reducing alcohol-related injury but neither classic intimate partner violence nor substance abuse interventions have adequately integrated assessment and treatment for these co-occurring conditions. The overall goal of this study is to determine whether a motivational intervention delivered at the time of an Emergency Department visit will reduce heavy drinking and improve the safety of women experiencing intimate partner violence. METHODS AND DESIGN We are completing data collection for a randomized controlled trial enrolling 600 female patients, age 18-64, presenting to one of two urban Emergency Departments, who self-disclose both problem drinking and intimate partner violence. Eligible patients are randomized to a brief manual-guided motivational intervention, and a phone booster at 10 days. The intervention, which is delivered by masters-level therapists during the Emergency Department visit, is recorded and monitored for fidelity. Primary outcomes are episodes of heavy drinking and incidents of intimate partner violence, assessed weekly by Interactive Voice Response System for 12 weeks and at 3, 6 and 12 months by interviewers blinded to group assignment. To identify the impact of assessment alone, we included a no-contact control group assessed only once at 3 months. Secondary outcomes include violence severity, changes in the Composite Abuse Scale and alcohol quantity/frequency, along with other health-related behaviors. The analysis will also explore the impact of likely mediators and moderators of the intervention. DISCUSSION While screening and intervention for intimate partner violence is now recommended for women of child bearing age in health care settings, there is a need for rigorous evaluations of what works for whom. Upon completion, we will have high-quality evidence regarding the effectiveness of a low-intensity, brief motivational intervention, delivered by social workers in the Emergency Department setting, for decreasing episodes of heavy drinking and intimate partner violence. Ultimately, this is a model could be generalizable to other acute health care settings. TRIAL REGISTRATION ClinicalTrials.gov REGISTRATION NUMBER NCT01207258.
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Affiliation(s)
- Karin V Rhodes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Center for Emergency Care Policy Research, Department of Emergency Medicine 1st Floor Ravdin, HUP, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Melissa Rodgers
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Marilyn Sommers
- School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Alexandra Hanlon
- School of Nursing, University of Pennsylvania, Philadelphia, USA
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Rhodes KV, Grisso JA, Rodgers M, Gohel M, Witherspoon M, Davis M, Dempsey S, Crits-Christoph P. The anatomy of a community health center system-level intervention for intimate partner violence. J Urban Health 2014; 91:107-21. [PMID: 23917943 PMCID: PMC3907622 DOI: 10.1007/s11524-013-9816-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The US Preventive Services Task Force (USPSTF) now recommends screening for intimate partner violence (IPV) as part of routine preventive services for women. However, there is a lack of clarity as to the most effective methods of screening and referral. We conducted a 3-year community-based mixed-method participatory research project involving four community health centers that serve as safety net medical providers for a predominately indigent urban population. The project involved preparatory work, a multifaceted systems-level demonstration project, and a sustainability period with provider/staff debriefing. The goal was to determine if a low-tech system-level intervention would result in an increase in IPV detection and response in an urban community health center. Results highlight the challenges, but also the opportunities, for implementing the new USPSTF guidelines to screen all women of childbearing years for intimate partner violence in resource-limited primary care settings.
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Affiliation(s)
- Karin V Rhodes
- School of Medicine, University of Pennsylvania, Philadelphia, USA,
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Crits-Christoph P, Gallop R, Sadicario JS, Markell HM, Calsyn DA, Tang W, He H, Tu X, Woody G. Predictors and moderators of outcomes of HIV/STD sex risk reduction interventions in substance abuse treatment programs: a pooled analysis of two randomized controlled trials. Subst Abuse Treat Prev Policy 2014; 9:3. [PMID: 24433412 PMCID: PMC3929547 DOI: 10.1186/1747-597x-9-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/08/2014] [Indexed: 11/17/2022]
Abstract
Background The objective of the current study was to examine predictors and moderators of response to two HIV sexual risk interventions of different content and duration for individuals in substance abuse treatment programs. Methods Participants were recruited from community drug treatment programs participating in the National Institute on Drug Abuse Clinical Trials Network (CTN). Data were pooled from two parallel randomized controlled CTN studies (one with men and one with women) each examining the impact of a multi-session motivational and skills training program, in comparison to a single-session HIV education intervention, on the degree of reduction in unprotected sex from baseline to 3- and 6- month follow-ups. The findings were analyzed using a zero-inflated negative binomial (ZINB) model. Results Severity of drug use (p < .01), gender (p < .001), and age (p < .001) were significant main effect predictors of number of unprotected sexual occasions (USOs) at follow-up in the non-zero portion of the ZINB model (men, younger participants, and those with greater severity of drug/alcohol abuse have more USOs). Monogamous relationship status (p < .001) and race/ethnicity (p < .001) were significant predictors of having at least one USO vs. none (monogamous individuals and African Americans were more likely to have at least one USO). Significant moderators of intervention effectiveness included recent sex under the influence of drugs/alcohol (p < .01 in non-zero portion of model), duration of abuse of primary drug (p < .05 in non-zero portion of model), and Hispanic ethnicity (p < .01 in the zero portion, p < .05 in the non-zero portion of model). Conclusion These predictor and moderator findings point to ways in which patients may be selected for the different HIV sexual risk reduction interventions and suggest potential avenues for further development of the interventions for increasing their effectiveness within certain subgroups.
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Kornstein SG, Russell JM, Spann ME, Crits-Christoph P, Ball SG. Duloxetine in the treatment of generalized anxiety disorder. Expert Rev Neurother 2014; 9:155-65. [DOI: 10.1586/14737175.9.2.155] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Mooney TK, Gibbons MBC, Gallop R, Mack RA, Crits-Christoph P. Psychotherapy credibility ratings: patient predictors of credibility and the relation of credibility to therapy outcome. Psychother Res 2013; 24:565-77. [PMID: 24219179 DOI: 10.1080/10503307.2013.847988] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The current investigation examined the relation between credibility ratings for adult psychotherapies and a variety of patient factors as well as the relation between credibility ratings and subsequent symptom change. METHOD A pooled study database that included studies evaluating the efficacy of cognitive and psychodynamic therapies for a variety of disorders was used. For all studies, a three-item credibility scale was administered at session 2. Patient variables at baseline were used to predict early treatment credibility. RESULTS Early symptom improvement, age, education, and expectation of improvement were all significantly predictive of credibility scores at session 2. In one combined multiple regression model controlling for treatment, study, and early symptom change, age, education, and expectation of improvement remained significantly predictive of credibility scores. Credibility was predictive of subsequent symptom change even when controlling for age, education, expectation of improvement, and early symptom improvement. CONCLUSIONS These findings suggest that age and education, in addition to expectations of improvement and the amount of early symptom improvement, may influence the patient's perceptions of the credibility of a treatment rationale early in the treatment process and that credibility ratings predict subsequent symptom change.
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Affiliation(s)
- Tessa Katherine Mooney
- a University of Pennsylvania Medical Center, Center for Psychotherapy Research, Psychiatry , Philadelphia , PA , USA
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Wiltsey Stirman S, Calloway A, Toder K, Miller CJ, Devito AK, Meisel SN, Xhezo R, Evans AC, Beck AT, Crits-Christoph P. Community mental health provider modifications to cognitive therapy: implications for sustainability. Psychiatr Serv 2013; 64:1056-9. [PMID: 24081406 PMCID: PMC3851297 DOI: 10.1176/appi.ps.201200456] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study identified modifications to an evidence-based psychosocial treatment (cognitive therapy) within a community mental health system after clinicians had received intensive training and consultation. METHODS A coding system, consisting of four types of contextual modifications, 12 types of content-related modifications, seven levels at which modifications can occur, and a code for changes to training or evaluation processes, was applied to data from interviews with 27 clinicians who treat adult consumers within a mental health system. RESULTS Nine of 12 content modifications were endorsed, and four (tailoring, integration into other therapeutic approaches, loosening structure, and drift) accounted for 65% of all modifications identified. Contextual modifications were rarely endorsed by clinicians in this sample. Modifications typically occurred at the client or clinician level. CONCLUSIONS Clinicians in community mental health settings made several modifications to an evidence-based practice (EBP), often in an effort to improve the fit of the intervention to the client's needs or to the clinician's therapeutic style. These findings have implications for implementation and sustainability of EBPs in community settings, client-level outcomes, and training and consultation.
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Stirman SW, Gutiérrez-Colina A, Toder K, Esposito G, Barg F, Castro F, Beck AT, Crits-Christoph P. Clinicians' perspectives on cognitive therapy in community mental health settings: implications for training and implementation. Adm Policy Ment Health 2013; 40:274-85. [PMID: 22426739 PMCID: PMC3434254 DOI: 10.1007/s10488-012-0418-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Policymakers are investing significant resources in large-scale training and implementation programs for evidence-based psychological treatments (EBPTs) in public mental health systems. However, relatively little research has been conducted to understand factors that may influence the success of efforts to implement EBPTs for adult consumers of mental health services. In a formative investigation during the development of a program to implement cognitive therapy (CT) in a community mental health system, we surveyed and interviewed clinicians and clinical administrators to identify potential influences on CT implementation within their agencies. Four primary themes were identified. Two related to attitudes towards CT: (1) ability to address client needs and issues that are perceived as most central to their presenting problems, and (2) reluctance to fully implement CT. Two themes were relevant to context: (1) agency-level barriers, specifically workload and productivity concerns and reactions to change, and (2) agency-level facilitators, specifically, treatment planning requirements and openness to training. These findings provide information that can be used to develop strategies to facilitate the implementation of CT interventions for clients being treated in public-sector settings.
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Affiliation(s)
- Shannon Wiltsey Stirman
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 S. Huntington Ave (116B3), Boston, MA 02130, USA.
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Abstract
BACKGROUND Little in known about the extent to which outcome measures used in studies of the treatment of cocaine dependence are associated with longer-term use and with broader measures of clinical improvement. The current study examined reductions in use, and abstinence-oriented measures, in relation to functioning and longer-term clinical benefits in the treatment of cocaine dependence. METHODS Overall drug use, cocaine use, and functioning in a number of addiction-related domains for 487 patients diagnosed with DSM-IV cocaine dependence and treated with one of four psychosocial interventions in the NIDA Cocaine Collaborative Treatment Study were assessed monthly during 6 months of treatment and at 9, 12, 15, and 18 month follow-up. RESULTS Measures of during-treatment reduction in use were moderately correlated with drug and cocaine use measures 12 months, but showed non-significant or small correlations with measures of functioning at 12 months. Highest correlations were evident for abstinence measures (maximum consecutive days abstinence and completely abstinent) during treatment in relation to sustained (3 month) abstinence at 12 months. Latent class analysis of patterns of change over time revealed that most patients initially (months 1 to 4 of treatment) either became abstinent immediately or continued to use every month. Over the couse of follow-up, patients either maintained abstinence or used regularly - intermittent use was less common. CONCLUSIONS There were generally small associations between various measures of cocaine use and longer-term clinical benefits, other than abstinence was associated with continued abstinence. No one method of measuring outcome of treatment of cocaine dependence appears superior to others.
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Affiliation(s)
- Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
| | - Robert Gallop
- Applied Statistics Program, Department of Mathematics, West Chester University, 25 University Avenue, West Chester, PA 19383, USA
| | | | - Jaclyn S. Sadicario
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
| | - George Woody
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
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