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Magill M, Martino S, Wampold BE. Defining the therapeutic relationship in the context of alcohol use, other drug use, and behavior change: Principles and practices. J Subst Use Addict Treat 2024; 163:209398. [PMID: 38754554 DOI: 10.1016/j.josat.2024.209398] [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] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/21/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
OVERVIEW This article contributes to knowledge and practice of core processes that are shared by evidence-based alcohol or other drug (AOD) therapies. It is the fourth in a series with this aim, and here we discuss perhaps the most universally acknowledged ingredient of effective therapy - the therapeutic relationship. We consider various related terms and definitions in the literature, but in the present review, we offer a definition that underscores the context of behavior change. METHOD This study conducted a literature review and qualitative content analysis to derive a set of principles and practices for facilitating and maintaining the therapeutic relationship. The sources for this review included government-issued practice guidelines, therapy manuals or books, demonstration videos, and peer-reviewed articles (61 sources). The content analysis was performed in NVIVO, and reliability analysis showed moderate agreement between raters (kappa = 0.60). RESULTS Six principles and 16 practices were identified. The distribution of principles and practices could be broken into three categories: 1) the facilitation of client behavior change mechanisms (i.e., self-determination, motivation, self-efficacy), 2) partnership considerations (e.g., goal and task alignment), and 3) therapist interpersonal skills (e.g., empathy). CONCLUSIONS The therapeutic relationship is foundational to the behavior change process. We frame it as a combination of broader interpersonal considerations and attention to key mechanisms of client behavior change. The present work provides a novel resource for trainees, clinicians, and clinical supervisors interested in fostering therapy relationships with clients in AOD or other behavior change settings.
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Affiliation(s)
- Molly Magill
- Brown University, Providence, RI, United States of America.
| | - Steve Martino
- Yale University, New Haven, CT, United States of America
| | - Bruce E Wampold
- University of Wisconsin, Madison, WI, United States of America
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Holmes MB, Jackson G, George SZ. Clinimetric Properties of the Working Alliance Inventory and Credibility Expectancy Questionnaire: Screening Options for Musculoskeletal Pain. Arch Phys Med Rehabil 2024:S0003-9993(24)00834-7. [PMID: 38432329 DOI: 10.1016/j.apmr.2024.02.724] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To investigate clinimetric properties of two surveys used to evaluate common factors in the patient-provider relationship and present screener options for the assessment of common factors and report their correlation with pain and functional outcomes. DESIGN Observational cohort SETTING: Outpatient physical therapy PARTICIPANTS: 100 individuals (58% females, mean age = 34, sd = 15) presenting to physical therapy with musculoskeletal pain in the following regions: 44% lower extremity 36% spine, 19% upper extremity 1% undetermined. INTERVENTION Not applicable MAIN OUTCOME MEASURES: Participants completed the Working Alliance Inventory (WAI) and the Credibility and Expectancy Questionnaire (CEQ). Exploratory factor analysis (EFA) explored factor structure of the WAI and CEQ. Internal consistency was evaluated for scales derived from items retained based on factor loadings.Finally, options for screener tools were proposed and assessed based on their correlation to original surveys as well as pain and functional outcomes. RESULTS The data supported a four-factor structure for the surveys. Some WAI items were excluded due to cross-loading.The derived four-factor scales demonstrated strong correlations with the original surveys (r = .89-.99) and exhibited good internal consistency (α = .824-.875). Two screening options were suggested: one retaining 11 of the original 18 items and the other comprising just 3 items. Both screening tools correlated with the original surveys and showed associations with improvements in pain and functional outcomes (r = -.21-.34). CONCLUSION The proposed screeners provide concise measurement options to facilitate use in clinical practice. These tools can aid in facilitating patient communication specifically addressing patient expectation and understanding the tasks required to enact behavior change.
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Affiliation(s)
- Mary Beth Holmes
- Department of Physical Therapy, Boston University, Boston, Massachusetts.
| | - Gabrielle Jackson
- Department of Physical Therapy, Boston University, Boston, Massachusetts
| | - Steven Z George
- Duke Clinical Research Institute, Durham, North Carolina and department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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Cruwys T, Lee GC, Robertson AM, Haslam C, Sterling N, Platow MJ, Williams E, Haslam SA, Walter ZC. Therapists who foster social identification build stronger therapeutic working alliance and have better client outcomes. Compr Psychiatry 2023; 124:152394. [PMID: 37216806 DOI: 10.1016/j.comppsych.2023.152394] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/08/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND For decades we have known that therapeutic working alliance is a key contributor to client engagement and positive outcomes in therapy. However, we have made little progress in narrowing down its determinants, which is critical in supporting trainees to optimize such alliance. We make a case for the value of incorporating social psychological frameworks into models of alliance and explore the role of social identity processes in the development of therapeutic alliance. METHOD Across two studies, over 500 psychotherapy clients completed validated measures of alliance, social identification with their therapist, positive therapy outcomes, and a range of client and therapist characteristics. FINDINGS Social identification strongly predicted alliance in both samples, whereas client and therapist characteristics showed few such associations. Alliance mediated the relationship between social identification and positive therapy outcomes. In addition, we found evidence that (a) personal control is a key psychological resource in therapy that arises from social identification, and (b) therapists who engage in identity leadership (i.e., who represent and build a social identity that they share with clients) are more likely to foster social identification and its downstream benefits. INTERPRETATION These data show that social identity processes are key to the emergence of working alliance. We conclude with a discussion of how recent social identity and identity leadership interventions might be adapted to train therapists in relevant identity-building skills.
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Affiliation(s)
- Tegan Cruwys
- School of Medicine and Psychology, 39 Science Rd, The Australian National University, Canberra ACT 2601 Australia.
| | - Georgina C Lee
- School of Medicine and Psychology, 39 Science Rd, The Australian National University, Canberra ACT 2601 Australia
| | - Alysia M Robertson
- School of Medicine and Psychology, 39 Science Rd, The Australian National University, Canberra ACT 2601 Australia
| | - Catherine Haslam
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
| | - Nikola Sterling
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
| | - Michael J Platow
- School of Medicine and Psychology, 39 Science Rd, The Australian National University, Canberra ACT 2601 Australia
| | - Elyse Williams
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
| | - S Alexander Haslam
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
| | - Zoe C Walter
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
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Brockmeyer T, Titzmann M, Zipfel S, Wild B, Resmark G, Teufel M, Giel K, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Löwe B, Tagay S, Rothermund E, Zeeck A, Herzog W, Friederich HC. The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa. Behav Res Ther 2023; 163:104285. [PMID: 36913844 DOI: 10.1016/j.brat.2023.104285] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
Previous research has shown a robust association between sudden gains (SGs) and treatment outcome in psychotherapy for various mental disorders including anorexia nervosa (AN). However, little is known about factors contributing to SGs. This study investigated the role of general change mechanisms in body-weight related SGs in AN. Data were drawn from a randomized-controlled trial on cognitive-behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for adult outpatients with AN. Session-level data on the general change mechanisms 'clarification' (insight), 'mastery' (coping), and 'therapeutic relationship' were analyzed. Pre-gain sessions were compared with control (pre-pre-gain) sessions in 99 patients with a SG in body weight. Additionally, propensity score matching was used to compare data from pre-gain sessions from 44 patients with SG and data from the corresponding session from 44 patients without SG. In the pre-gain session, patients experienced higher levels of clarification and mastery but not therapeutic relationship. Compared to patients without a SG, patients with a SG likewise experienced more clarification and mastery but not a better therapeutic relationship in the pre-gain/corresponding session. CBT and FPT did not differ regarding these effects. The findings suggest that general change mechanisms contribute to SGs in CBT and FPT for AN.
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Affiliation(s)
- Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany; Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Marieke Titzmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Beate Wild
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University Hospital, Essen, Germany
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Herpertz
- Department for Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-Hospital and University Hospital Muenster, Muenster, Germany
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Tagay
- Faculty of Social Sciences, TH Köln-University of Applied Sciences, Köln, Germany
| | - Eva Rothermund
- Ulm University Medical Center, Department of Psychosomatic Medicine and Psychotherapy, Ulm, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Herzog
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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Samantaray NN, Mishra A, Singh AR, Sudhir PM, Singh P. Anxiety sensitivity as a predictor, and non-specific therapeutic factors as predictors and mediators of CBT outcome for obsessive-compulsive disorder in a naturalistic mental health setting. J Affect Disord 2023; 324:92-101. [PMID: 36584701 DOI: 10.1016/j.jad.2022.12.085] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/09/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We examined the unique predictive strength of anxiety sensitivity (AS) and the role of expectancy, credibility, and therapeutic alliance (TA) as predictors and mediators of cognitive-behavioral treatment (CBT) outcomes in obsessive-compulsive disorder (OCD). METHOD The current study is a prospective cohort study. Participants (N = 116) were treatment-seeking individuals with a primary diagnosis of OCD. Independent raters assessed patients on Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Anxiety Sensitivity Index-3 at baseline, post-intervention, and three-month follow-up. Participants responded to the Credibility and Expectancy questionnaire and Working Alliance Inventory-Short revised at baseline, first-session, and mid-session. RESULTS The individual addition of AS, end-of-first-session credibility and expectancy, mid-session credibility and expectancy, and therapeutic alliance predicted significant CBT outcomes. There was a moderate positive correlation between baseline OCD severity and the global score of AS, but a weak one with AS dimensions. Both expectancy and credibility significantly improved from baseline to end-of-first-session treatment. End-of-first and third-session outcome expectancies, not credibility, have significant, indirect effects on OCD CBT outcomes. CONCLUSIONS AS, within-session credibility and expectancies and TA independently predict CBT outcomes. Within-sessions outcome expectancies mediate CBT outcomes in OCD, not credibility. Expectancy and credibility both include state-like elements that can be influenced to enhance the outcomes of CBT. Proposals for reducing treatment barriers in CBT for OCD are offered.
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Affiliation(s)
- Narendra Nath Samantaray
- Dept. of Clinical Psychology, School of Medical and Paramedical Science, Mizoram University, Aizawl 796004, India.
| | - Abinash Mishra
- Dept. of Clinical Psychology, Mental Health Institute (Centre of Excellence), SCB Medical College & Hospital, Cuttack 753007, India
| | | | - Paulomi M Sudhir
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Preeti Singh
- Dept. of Psychiatry, Pt. Jawahar Lal Nehru Memorial Medical College, Raipur 492001, India
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Behan D. Do clients train therapists to become eclectic and use the common factors? A qualitative study listening to experienced psychotherapists. BMC Psychol 2022; 10:183. [PMID: 35897054 PMCID: PMC9327163 DOI: 10.1186/s40359-022-00886-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychotherapists must choose from an overwhelming number of theoretical models and empirically supported treatments to guide their work. Meta-analytic studies show there is comparable efficacy among the choices, making the decision about which approach to use difficult. Research indicates there are pantheoretical elements found in all effective models, called the common factors, which can offer psychotherapists a focusing point to maximize their effectiveness regardless of their chosen approach. Most psychotherapists begin practicing from a traditional theoretical orientation, but then their approach evolves over time toward an unintentional eclecticism, derived primarily from their practice experience with clients. METHODS This exploratory qualitative study conducted in-depth interviews with six experienced clinical social workers about their evolution as psychotherapists and what they believe creates change in psychotherapy. The interviews were conducted using standardized prompts and then coded and analyzed utilizing thematic analysis based on a six-phase framework. RESULTS The analysis suggests the psychotherapists had evolved to conducting therapy via an implicit and unique approach based on an unintentional heavy use of common factors. Five prominent themes emerged as central components of change in psychotherapy: the therapeutic relationship as a primary change agent, the importance of the therapist genuineness, the need to acknowledge and act upon a poor therapist-client match, the client bearing the primary responsibility for change, and the therapists' development of unintended eclecticism in response to client interactions. CONCLUSIONS In practice, most psychotherapists start practicing from a traditional theoretical orientation only to find their approach evolves over time toward an informal eclecticism featuring common factors. This common factors-based eclecticism emerges primarily from practice experience with clients. These findings suggest an avenue for further inquiry-if psychotherapists are going to gradually evolve in an unplanned eclectic direction guided by their client interactions, are they also concurrently and inherently drawn to the common factors? If the answer proves to be yes, what are the implications for early training? Should the gradual emphasis toward common factors be supplanted with a more intentional and efficient focus on them in the training of students and early career clinicians?
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Affiliation(s)
- Douglas Behan
- School of Social Work, Rutgers, The State University of New Jersey, 390 George St. 3rd Floor, New Brunswick, NJ, 08901, USA.
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Magill M, Martino S, Wampold B. Goal setting and monitoring with alcohol and other drug use disorders: Principles and practices. J Subst Abuse Treat 2022; 132:108650. [PMID: 34756763 PMCID: PMC8671316 DOI: 10.1016/j.jsat.2021.108650] [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: 06/04/2021] [Revised: 09/09/2021] [Accepted: 10/13/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION This work builds on a small body of literature that explores core processes in psychotherapy, behavior change, and evidence-based alcohol or other drug (AOD) therapies. Here, this paper discusses two separate but dependent processes. The research team defines goal setting and goal monitoring as collaborative processes where clinicians and clients identify and formulate therapeutic goals; actionable objectives; and revisit, measure, and renegotiate these plans via a standardized procedure over time. METHOD Study methods included a literature review and qualitative content analysis to derive a set of principles and practices of goal setting and monitoring. The research team used source documents (i.e., literature reviews, therapy manuals, and government-issued practice guidelines) and videos (i.e., therapy demonstration videos), and we performed analyses in NVIVO. RESULTS The study identified ten principles and 32 practices. The principles suggest that goal setting and monitoring can be characterized as a collaborative, explicit, and standardized approach to engaging in goal-directed therapeutic work. The term goal-directed therapeutic work connotes a shift toward a more accountable frame for care than has been previously emphasized in the literature. The identified practices were organized into five sub-themes related to goal setting (10 practices), goal monitoring (10 practices), as well as practices specific to mechanisms of goal pursuit and behavior change. These practices involved ways to attend to client self-determination (4 practices), motivation (4 practices), and self-efficacy (4 practices). CONCLUSIONS Goal setting and monitoring are a collaborative means of mapping and tracking a course of mutually accountable treatment. The current work is a novel resource for trainees, clinicians, and clinical supervisors interested in care based on evidence-based principles and practices of AOD and other behavior change therapies.
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Elhorst JP. The dynamic general nesting spatial econometric model for spatial panels with common factors: Further raising the bar. Jahrb Reg Wiss 2021; 42:249-267. [PMID: 38624972 PMCID: PMC8631700 DOI: 10.1007/s10037-021-00163-w] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/24/2022]
Abstract
The dynamic general nesting spatial econometric model for spatial panels with common factors is the most advanced model currently available. It accounts for local spatial dependence by means of an endogenous spatial lag, exogenous spatial lags, and a spatial lag in the error term. It accounts for dynamic effects by means of the dependent variable lagged in time, and the dependent variable lagged in both space and time. Finally, it accounts for global cross-sectional dependence by means of cross-sectional averages or principal components with heterogeneous coefficients, which generalizes the traditional controls for time-invariant and spatial-invariant variables by unit-specific and time-specific effects. This paper provides an overview of the main arguments in favor of each of these model components, as well as some potential pitfalls.
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Affiliation(s)
- J. Paul Elhorst
- Department of Economics, Econometrics and Finance, University of Groningen, P.O.Box 800, 9700AV Groningen, The Netherlands
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Seaward H, Wangmo T, Vogel T, Graf M, Egli-Alge M, Liebrenz M, Elger BS. What characterizes a good mental health professional in court-mandated treatment settings?: Findings from a qualitative study with older patients and mental health care professionals. BMC Psychol 2021; 9:121. [PMID: 34404482 PMCID: PMC8371872 DOI: 10.1186/s40359-021-00624-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Therapist-related activities and characteristics such as empathy and genuineness are factors that significantly contribute to psychotherapy outcome. As they play a role in psychotherapy more generally, it can be expected that they are equally important in the treatment of court-mandated patients more specifically. At the same time, these treatment settings come with specific challenges-e.g. due to coercion and control-and it could thus be that some therapist-related characteristics might have a different empathy on the therapy. This interview study sought to investigate service providers' and users' perspectives on therapist-related characteristics in the context of detention. METHODS We conducted a qualitative interview study with 41 older incarcerated persons mandated to treatment, and 63 mental health professionals (MHP). The data analysis followed thematic analysis. RESULTS Patients and experts both emphasized the importance of treating patients with respect by taking a humanistic approach, that is, condemn the deeds but embrace the person and display genuine interest in supporting patients with any issue or concern that is of relevance to them. Furthermore, interviewees underscored that the coerciveness of the therapy context required to incorporate patients' wishes into treatment planning, recognize and respond to the patients' needs, and allow some choice within the given framework. Such inclusive attitude was deemed critical to engage and motivate patients to participate in treatment. In addition, it was emphasized that feedback and advice by the therapists need to be concrete, detailed and applied to each person's current situation. Lastly, patients questioned MHP's qualification when they did not progress in therapy. DISCUSSION Our findings indicate that some therapist-related activities and characteristics are of particular importance in court-mandated settings. These include genuine interest in the patient, a respectful and positive attitude, as well as the capacity to target sensitive issues in a directive but non-confrontational manner. Further research needs to identify specific expressions and behaviors that are linked to the aforementioned characteristics in the forensic context. Our study therefore contributes to much-needed empirical research on clinician and patient perspectives on therapist characteristics and activities in the treatment of court-mandated patients.
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Affiliation(s)
- Helene Seaward
- Institute for Biomedical Ethics, University Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Tobias Vogel
- Psychiatric Hospital of the University of Basel, Forensic Psychiatric Hospital, Basel, Switzerland
| | - Marc Graf
- Psychiatric Hospital of the University of Basel, Forensic Psychiatric Hospital, Basel, Switzerland
| | | | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Center for Legal Medicine (CURML), Medical Faculty, University of Geneva, Geneva, Switzerland
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Li R, Joyeux R, Ripple RD. Income and energy consumption in Asia-Pacific countries - A panel cointegration analysis enhanced with common factors. Heliyon 2021; 7:e07090. [PMID: 34136683 DOI: 10.1016/j.heliyon.2021.e07090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/09/2021] [Accepted: 05/13/2021] [Indexed: 11/22/2022] Open
Abstract
The research presented in this paper re-examines the relationship between energy consumption and income for a panel of Asian economies for the period 1971-2018. The Asian economies represent a dynamic, diverse, and interesting set of countries on which to base an examination of these relationships and the tendencies for these economies to be on a path of convergence and integration in their energy consumption and use characteristics. Our convergence analysis provides evidence of convergence in energy intensity among the countries. Panel data methodologies are employed to gain the advantage of increased explanatory power of the econometric analysis. Importantly, we incorporate common factors as a means of accounting for variables beyond the bivariate relationship. The results find support for the flow of causality running from income to energy consumption, albeit with short-run feedback. As a result, current policies aimed at reducing energy intensity and CO2 emissions are not expected to significantly inhibit economic growth. The results are consistent with the seminal paper by Kraft and Kraft (1978). Additionally, we find the long-run income elasticity estimates for the panel double in size when unobserved common factors are excluded.
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Magill M, Martino S, Wampold B. The principles and practices of psychoeducation with alcohol or other drug use disorders: A review and brief guide. J Subst Abuse Treat 2021; 126:108442. [PMID: 34116812 DOI: 10.1016/j.jsat.2021.108442] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/11/2021] [Accepted: 04/16/2021] [Indexed: 12/25/2022]
Abstract
OVERVIEW In the current work, we build upon a small body of literature that delineates cross-cutting factors, or processes, of evidence-based alcohol or other drug (AOD) therapies. Here, we discuss Psychoeducation. We define psychoeducation as a brief process of therapy focused on the communication of varied aspects of disease- and/or treatment-related information. METHOD The authors conducted a literature review and qualitative content analysis to derive a set of principles and practices of psychoeducation. The review used source documents (i.e., literature reviews, therapy manuals, and government-issued practice guidelines) and videos (i.e., therapy demonstration videos), and we performed analyses in NVIVO. RESULTS The review identified nine principles and 21 practices. Together, the principles suggest that psychoeducation in evidence-based addictions therapies can be characterized as a collaborative approach to teaching, education, or other provision of information. The term collaborative denotes a shift in emphasis from compliance to a more egalitarian partnership focused on meeting individual health needs. Specific practices included ways to transition to psychoeducation (e.g., provide rationale and promote expectancy), teaching methods in psychoeducation (e.g., use plain language), tailoring content in psychoeducation (e.g., to learning style, to cultural worldview), and methods for facilitating a dialogue about the information (i.e., five question types), for facilitating understanding and retention of the information (e.g., tailor to individual needs, use of varied teaching modalities), and how to end psychoeducation and engage in related goal-setting, where applicable. CONCLUSIONS We frame psychoeducation as a collaborative approach to teaching where client engagement, understanding, and utilization of the information provided is the central goal. We offer a novel resource with pragmatic value to trainees, providers, and clinical supervisors who do not consider themselves aligned with a single evidence-based modality but who may benefit from training and proficiency assessment in core, behavioral health counseling competencies.
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Affiliation(s)
- Molly Magill
- Brown University, Providence, RI, United States of America.
| | - Steve Martino
- Yale University, New Haven, CT, United States of America; VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Bruce Wampold
- University of Wisconsin, Madison, WI, United States of America
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Fox ST, Ghelfi EA, Goates-Jones MK. Common Factors in Biofeedback Administered by Psychotherapists. Appl Psychophysiol Biofeedback 2021; 46:151-9. [PMID: 33527224 DOI: 10.1007/s10484-021-09504-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
Common factors are nonspecific therapeutic elements common across different varieties of psychotherapy. In a recent study, 68 expert psychotherapy researchers with a variety of allegiances collectively rated biofeedback as being negatively associated with many common factors (Tschacher et al. in Clin Psychol Psychother 21(1):82-96, 2014), including the therapeutic alliance. However, it seems implausible that biofeedback could benefit so many people while being incompatible with the therapeutic alliance and other common factors. The present study investigated the experiences of biofeedback clients who participated in a brief heart rate variability biofeedback protocol in order to explore the potential roles of common factors in biofeedback. The results of this study offer preliminary evidence that many common factors-including therapeutic alliance, self-efficacy expectation, mastery experiences, provision of explanatory scheme, mindfulness, and even cognitive restructuring-may play a role in biofeedback outcomes. Future research on this topic should include mediation and moderation models investigating the role of specific common factors on outcome and process studies to help determine what clinician behaviors are most helpful. Deeper investigation of common factors in biofeedback may benefit future biofeedback research and practice and address the concerns of colleagues outside of the biofeedback community who believe that biofeedback is at odds with common factors.
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Magill M, Martino S, Wampold BE. The process of skills training: A content analysis of evidence-based addiction therapies. J Subst Abuse Treat 2020; 116:108063. [PMID: 32741504 PMCID: PMC7399208 DOI: 10.1016/j.jsat.2020.108063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/04/2020] [Revised: 05/25/2020] [Accepted: 06/11/2020] [Indexed: 11/27/2022]
Abstract
OVERVIEW This work builds on previous efforts to delineate cross-cutting factors of evidence-based therapies. In this report, we target a single therapeutic factor-skills training for addictive behavior change-and we operationalize this factor in a manner that will aid clinical training and quality control. Specifically, we identify principles, which we defined as broader understandings on the part of the therapist that must be kept in mind when implementing a specific therapeutic practice. We define a practice as discrete action step or specific type of intervention that the therapist uses when addressing skills training content with clients. METHOD We conducted a literature review and qualitative content analysis of 30 source documents (i.e., therapy manuals, literature reviews, and government issued practice guidelines) and videos (i.e., therapy demonstration videos). We performed analysis of source materials in NVIVO. RESULTS We identified 10 principles and 30 therapeutic practices. Together, the principles suggest that skills training in evidence-based addiction therapies can be characterized as a client-centered approach to teaching and behavioral practice. The identified practices fell into four function themes: 1) client-centered goal-setting, 2) building client self-efficacy, 3) engaging in teaching, and 4) engaging in practice. CONCLUSIONS When the identified principles and practices are combined, they can inform a fidelity-based approach to behavioral skills training that is applicable to a wide range of alcohol or other drug (AOD) content topics, therapeutic modalities, and implementation settings. We discuss future implications regarding standardized training and fidelity assessment.
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Affiliation(s)
- Molly Magill
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI, United States of America.
| | - Steve Martino
- Yale University, New Haven, CT, United States of America
| | - Bruce E Wampold
- University of Wisconsin, Madison, WI, United States of America
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14
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Locher C, Mansour R, Koechlin H, Büchi S. Patient-appraised beneficial moments during inpatient psychiatric treatment. BMC Health Serv Res 2020; 20:734. [PMID: 32778097 PMCID: PMC7418414 DOI: 10.1186/s12913-020-05617-4] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric inpatients receive a multidisciplinary treatment approach, covering psychiatry, nursing, occupational therapy, and psychology. Research findings reveal that the effectiveness of any treatment is associated with three types of factors: specific (e.g., treatment techniques), common (e.g., clinician-patient relationship, patients' expectations) and extra-therapeutic. However, there is little published research on the factors and events which inpatients themselves consider to be beneficial ('beneficial moments'). METHODS Inpatients (N = 107) of a psychiatric clinic completed a questionnaire to elicit their appraisal of beneficial moments. A qualitative content analysis was applied. The coding procedure was conducted independently by two authors. RESULTS Self-appraised beneficial moments were found in five areas: therapy-specific components (number of quotations, N = 204), positive relationships (N = 140), clinical setting and environment (N = 52), inpatients' new insights (N = 36), and factors unrelated to either therapy or the clinic (N = 30). In total, 44% of the quotations were related to specific factors, 49% to common factors, and 7% to extra-therapeutic factors. CONCLUSIONS Inpatients judge both specific and common factors as crucial for the therapeutic benefit they gain during their stay at the clinic. Our results differ from meta-analytical findings, where the impact of specific factors on symptom improvement has shown to be much smaller (i.e., 17%) than appraised by patients in our study (i.e., 44%). Our study underlines the importance of a patient-centred care approach as well as shared decision making and patient-clinician communication. For clinical practice, knowledge of inpatients' perspectives on beneficial moments is crucial in order to reinforce precisely these therapeutic components.
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Affiliation(s)
- Cosima Locher
- School of Psychology, Plymouth University, Plymouth, UK. .,Clinic for Psychotherapy and Psychosomatics "Hohenegg", Meilen, Switzerland. .,Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland. .,Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ramin Mansour
- Clinic for Psychotherapy and Psychosomatics "Hohenegg", Meilen, Switzerland
| | - Helen Koechlin
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland.,Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan Büchi
- Clinic for Psychotherapy and Psychosomatics "Hohenegg", Meilen, Switzerland
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15
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Abstract
This paper describes a reformulated contextual model that uses cognitive theory (dual process theory), motivation theory (personality) and behavioral adaptation (self-correcting control systems) to show how anxiety and depression are caused, treated and prevented by an interaction between people and contexts. Depression and anxiety are the result of implicit beliefs (not cognitions) that all experience is unrewarding and threatening, these being components of the implicit belief that life is bad. Implicit beliefs are formed automatically from contextual cues and in healthy individuals are consistent with rational appraisal. They become more negative than reality through a process of adaptation when behaviors, directed by rational thinking, repeatedly create cues that signify lack of reward or threat. Such behaviors occur when social or other obligations lead people to choose behaviors that fail to satisfy their own unique goals in life and approach threatening situations, contrary to their automatic reactions. Therapeutic interventions and lifestyle change reverse these adaptive processes by positive experiences that create positive implicit beliefs, a change effected in different ways by contextual and specific mechanisms both of which correct the same fault of negative implicit beliefs. Effective therapeutic relationships and interventions are achieved by detecting and responding to a patient's unique needs and goals and their associated implicit beliefs. Mental health requires not only that people experience life as good as defined by their own goals and beliefs but also the avoidance of contexts where social and other pressures induce people to behave in ways inconsistent with their automatically generated feelings.
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Affiliation(s)
- Michael E Hyland
- Plymouth Marjon University, Derriford Road, Plymouth PL6 8BH, United Kingdom; University of Plymouth, Drakes Circus, Plymouth PL4 8AA, United Kingdom.
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16
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Hutsebaut J, Willemsen E, Bachrach N, Van R. Improving access to and effectiveness of mental health care for personality disorders: the guideline-informed treatment for personality disorders (GIT-PD) initiative in the Netherlands. Borderline Personal Disord Emot Dysregul 2020; 7:16. [PMID: 32789019 PMCID: PMC7416386 DOI: 10.1186/s40479-020-00133-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
Evidence-based treatment for patients suffering from personality disorders (PDs) is only available to a limited extend in the Netherlands. Consequently, most patients receive non-manualized, unspecialized care. This manuscript describes the background, rationale and design of the Guideline-Informed Treatment for Personality Disorders (GIT-PD) initiative. GIT-PD aims to provide a simple, principle-driven, 'common-factors' framework for the treatment of PDs. The GIT-PD framework integrates scientific knowledge, professional expertise and patient experience to design a good-enough practice, based on common factors. It offers a basic framework including general principles, a structured clinical pathway, a basic professional stance, interventions focused on common factors, and team and organizational strategies, based on common features of evidence-based treatments and generic competences of professionals. The GIT-PD initiative has had a large impact on the organization of treatment for PDs in the Netherlands. For countries with an interest in improving their health care system for PDs, it could serve as a template that requires only limited resources.
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Affiliation(s)
- Joost Hutsebaut
- Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands.,Centre of Expertise on Personality Disorders, Utrecht, The Netherlands
| | - Ellen Willemsen
- Centre of Expertise on Personality Disorders, Utrecht, The Netherlands.,Parnassia Psychomedical centre, The Hague, The Netherlands
| | - Nathan Bachrach
- GGZ Oost Brabant, Boekel, The Netherlands.,Rino Zuid, Eindhoven, The Netherlands.,Tilburg University, Tilburg, The Netherlands
| | - Rien Van
- Arkin Mental Health Centre, Amsterdam, The Netherlands
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17
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Abstract
Common conclusions from traditional psychotherapy research are that we still do not know how or why even our most well-studied interventions produce change, and that there is little evidence that any form of psychotherapy is generally more effective than any other. This has led some researchers to the so-called Dodo Bird Verdict, that all forms of psychotherapy are equally effective, and to the conclusion that what is at work are "common factors" that have little to do with treatment method. An alternative explanation, however, is that the traditional research paradigm is insufficiently sensitive to provide us with the required kind of knowledge. First, the outcome in typical RCTs is averaged across individuals, and at best complemented by a search for predictors in the form of stable individual differences. This means that this research stays at a group level of analysis and is insensitive to variation and change in individual patients. Second, the independent variable in RCTs does not consist in any well-controlled psychological intervention, but in large-scale treatment packages that contain a large number of interventions over a considerable time period. In other words, this research is insensitive to the effects of specific treatment interventions. Third, traditional psychotherapy research is insensitive to the therapist and patient as individual persons, and their specific interaction. It is argued that a person-oriented approach to psychotherapy, which is idiographic, holistic and interactional, may be able to overcome some of these problems by being more sensitive to (1) the treatment course of individual patients, and patterns during that course; (2) the effects of the specific interventions that are implemented over time, and (3) the personal characteristics of patient and therapist, and nuances of their interaction.
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Affiliation(s)
- Lars-Gunnar Lundh
- Department of Psychology, Lund University, Box 213, 221 00 Lund, Sweden
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18
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Abstract
Meta-analyses have consistently shown a wide variety of psychotherapeutic and pharmacological interventions to yield similar effect sizes, suggesting the possibility that those interventions share common factors that account for the vast majority of variance in clinical outcomes. Although mediation analyses are needed to know definitively whether factors common or specific to the interventions are responsible for clinical improvement, a large number of association studies suggest that a common set of characteristics representing the ways in which clinicians relate to their patients, and not the technical expertise of clinicians or the therapeutic modality in which they work, account for the majority of therapeutic change across all medical disciplines and cultures. These characteristics include clinician empathy, warmth, and genuineness, a capacity to maintain a positive regard for the patient in moments of vulnerability, and an ability to establish a strong therapeutic alliance and clinical narrative through which the patient understands their suffering and is challenged to change through health-promoting activities. These common factors are amenable to study to improve our knowledge of precisely how they produce clinical change. They can be taught across all medical disciplines, in order to deepen the shared understanding, interpersonal attunement, and alliance between clinicians and their patients, which together constitute the true science and art of healing.
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Affiliation(s)
- Bradley S Peterson
- Children's Hospital Los Angeles and the Keck School of Medicine, University of Southern California, CA, USA
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19
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Priebe S, Conneely M, McCabe R, Bird V. What can clinicians do to improve outcomes across psychiatric treatments: a conceptual review of non-specific components. Epidemiol Psychiatr Sci 2019; 29:e48. [PMID: 31412975 DOI: 10.1017/S2045796019000428] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Psychiatric treatments have specific and non-specific components. The latter has been addressed in an extensive literature on the placebo-effect in pharmacology and on common factors in psychotherapy. In the practice of mental health care, pharmacological, psychotherapeutic and social treatments are combined in complex interventions. This paper aims to review non-specific components across diverse psychiatric treatments and consider implications for practice and research. METHODS We conducted a non-systematic review of non-specific components across psychiatric treatments, their impact on treatment processes and outcomes, and interventions to improve them. RESULTS The identified research is heterogeneous, both in design and quality. All non-specific components capture aspects of how clinicians communicate with patients. They are grouped into general verbal communication - focusing on initial contacts, empathy, clarity of communication, and detecting cues about unspoken concerns - non-verbal communication, the framing of treatments and decision-making. The evidence is stronger for the impact of these components on process measures - i.e. therapeutic relationship, treatment satisfaction and adherence than on clinical outcomes - i.e. symptoms and relapse. A small number of trials suggest that brief training courses and simple methods for structuring parts of clinical consultations can improve communication and subsequently clinical outcomes. CONCLUSIONS Methodologically, rigorous research advancing current understandings of non-specific components may increase effectiveness across different treatments, potentially benefitting large numbers of patients. Brief training for clinicians and structuring clinical communication should be used more widely in practice.
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20
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Owczarzak J, Nguyen TQ, Mazhnaya A, Phillips SD, Filippova O, Alpatova P, Zub T, Aleksanyan R. Outcome evaluation of a " common factors" approach to develop culturally tailored HIV prevention interventions for people who inject drugs. Drug Alcohol Depend 2019; 199:18-26. [PMID: 30981045 PMCID: PMC6537906 DOI: 10.1016/j.drugalcdep.2019.02.015] [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] [Received: 07/13/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Current models of HIV prevention intervention dissemination involve packaging interventions developed in one context and training providers to implement that specific intervention with fidelity. Providers rarely implement these programs with fidelity due to perceived incompatibility, resource constraints, and preference for locally-generated solutions. Moreover, such interventions may not reflect local drug markets and drug use practices that contribute to HIV risk. PURPOSE This paper examines whether provider-developed interventions based on common factors of effective, evidence-based behavioral interventions led to reduction in drug-related HIV risk behaviors at four study sites in Ukraine. METHODS We trained staff from eight nongovernmental organizations (NGOs) to develop HIV prevention interventions based on a common factors approach. We then selected four NGOs to participate in an outcome evaluation. Each NGO conducted its intervention for at least N = 130 participants, with baseline and 3-month follow-up assessments. RESULTS At three sites, we observed reductions in the prevalence of both any risk in drug acquisition and any risk in drug injection. At the fourth site, prevalence of any risk in drug injection decreased substantially, but the prevalence of any risk in drug acquisition essentially stayed unchanged. CONCLUSIONS The common factors approach has some evidence of efficacy in implementation, but further research is needed to assess its effectiveness in reducing HIV risk behaviors and transmission. Behavioral interventions to reduce HIV risk developed using the common factors approach could become an important part of the HIV response in low resource settings where capacity building remains a high priority.
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Affiliation(s)
- J Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House Room 739, Baltimore, MD, 21205-1996, USA; Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Ave, Milwaukee, WI, 53202, USA
| | - TQ Nguyen
- Departments of Mental Health and Biostatistics, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 800, Baltimore, MD, 21205, USA; Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Ave, Milwaukee, WI, 53202, USA
| | - A Mazhnaya
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205-1996, USA; Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Ave, Milwaukee, WI, 53202, USA
| | - SD Phillips
- Department of Anthropology, Indiana University, Student Building 130, 701 E. Kirkwood Ave, Bloomington, IN, 47405, USA
| | - O Filippova
- Department of Sociology, V.N. Karazin Kharkiv National University, 6 Svobody Sq, Office 351, Kharkiv, Ukraine
| | - P Alpatova
- Institute of Social-Humanitarian Research, V.N. Karazin Kharkiv National University, 6 Svobody Sq, Office 351, Kharkiv, Ukraine
| | - T Zub
- Department of Sociology, V.N. Karazin Kharkiv National University, 6 Svobody Sq, Office 351, Kharkiv, Ukraine
| | - R Aleksanyan
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Ave, Milwaukee, WI, 53202, USA
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21
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Richardson CB, Morgan NR, Bleser JA, Aronson KR, Perkins DF. A novel approach for evaluating programs designed to serve military veterans: Using an adapted common components analysis. Eval Program Plann 2019; 72:145-151. [PMID: 30343224 DOI: 10.1016/j.evalprogplan.2018.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 06/08/2023]
Abstract
Evaluators are challenged to keep pace with the vast array of Veteran support programs operating in the United States, resulting in a situation in which many programs lack any evidence of impact. Due to this lack of evidence, there is no efficient way to suggest which programs are most effective in helping Veterans in need of support. One potential solution to this dilemma is to reconceptualize program evaluation, by moving away from evaluating programs individually to evaluating what is common across programs. The Common Components Analysis (CCA) is one such technique that aggregates findings from programs that have undergone rigorous evaluation at the level of program components (e.g., content, process, barrier reduction). Given that many Veteran programs lack outcome evidence from rigorous studies, an adaptation to CCA is needed. This report examines cross-sectional data from a pilot study using an adapted CCA across five domains of well-being (i.e., employment, education, legal/financial/housing, mental/physical health, and social/personal relationships). The purpose of this preliminary study is to determine the feasibility of eliciting program nominations and program components from Veterans via an online survey. When coupled with a longitudinal research design, this adaptation to CCA will allow for stronger causal claims about the expected impact of different program components within and across a variety of domains.
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Affiliation(s)
- Cameron B Richardson
- Clearinghouse for Military Family Readiness at Penn State, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA.
| | - Nicole R Morgan
- Clearinghouse for Military Family Readiness at Penn State, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA.
| | - Julia A Bleser
- Clearinghouse for Military Family Readiness at Penn State, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA.
| | - Keith R Aronson
- Clearinghouse for Military Family Readiness at Penn State, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA; Social Science Research Institute, The Pennsylvania State University, 114J Henderson Building, University Park, PA 16802, USA.
| | - Daniel F Perkins
- Clearinghouse for Military Family Readiness at Penn State, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA; Social Science Research Institute, The Pennsylvania State University, 114J Henderson Building, University Park, PA 16802, USA; Department of Agricultural Economics, Sociology and Education, The Pennsylvania State University, 107 Ferguson Bldg, University Park, PA 16802, USA.
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22
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Morgan NR, Davis KD, Richardson C, Perkins DF. Common components analysis: An adapted approach for evaluating programs. Eval Program Plann 2018; 67:1-9. [PMID: 29132065 DOI: 10.1016/j.evalprogplan.2017.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
Common Components Analysis (CCA) summarizes the results of program evaluations that utilize randomized control trials and have demonstrated effectiveness in improving their intended outcome(s) into their key elements. This area of research has integrated and modified the existing CCA approach to provide a means of evaluating components of programs without a solid evidence-base, across a variety of target outcomes. This adapted CCA approach (a) captures a variety of similar program characteristics to increase the quality of the comparison within components; (b) identifies components from four primary areas (i.e., content, process, barrier reduction, and sustainability) within specific programming domains (e.g., vocation, social); and (c) proposes future directions to test the extent to which the common components are associated with changes in intended program outcomes (e.g., employment, job retention). The purpose of this paper is to discuss the feasibility of this adapted CCA approach. To illustrate the utility of this technique, researchers used CCA with two popular employment programs that target successful Veteran reintegration but have limited program evaluation - Hire Heroes USA and Hire Our Heroes. This adapted CCA could be applied to longitudinal research designs to identify all utilized programs and the most promising components of these programs as they relate to changes in outcomes.
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Affiliation(s)
- Nicole R Morgan
- Clearinghouse for Military Family Readiness, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA.
| | - Kelly D Davis
- School of Social and Behavioral Health Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR 97330, USA.
| | - Cameron Richardson
- Clearinghouse for Military Family Readiness, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA.
| | - Daniel F Perkins
- Clearinghouse for Military Family Readiness, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA; Department of Agricultural Economics, Sociology and Education, The Pennsylvania State University, 107 Ferguson Bldg, University Park, PA 16802, USA.
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23
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Kidd SA, Davidson L, McKenzie K. Common Factors in Community Mental Health Intervention: A Scoping Review. Community Ment Health J 2017; 53:627-637. [PMID: 28194599 DOI: 10.1007/s10597-017-0117-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 06/15/2016] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
While there is considerable research and commentary devoted to common factors in psychotherapy, their implications for community mental health interventions are much less clear. In response, a scoping review was conducted to answer the question, 'What is the evidence base for common factors in community mental health intervention?' A comprehensive search of MEDLINE, PsycINFO, and Google Scholar was completed. A total of 60 publications were identified in this review with a focus primarily upon therapeutic alliance. Though methodologically diverse, this review supports the likely importance of alliance in the outcomes of community mental health interventions.
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Affiliation(s)
- Sean A Kidd
- Department of Psychiatry, University of Toronto, 1001 Queen St. W., Unit 2-1, #161, Toronto, ON, M6J 1H1, Canada.
| | - Larry Davidson
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, ON, USA
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24
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Plöderl M, Kunrath S, Cramer RJ, Wang J, Hauer L, Fartacek C. Sexual orientation differences in treatment expectation, alliance, and outcome among patients at risk for suicide in a public psychiatric hospital. BMC Psychiatry 2017; 17:184. [PMID: 28506219 PMCID: PMC5433065 DOI: 10.1186/s12888-017-1337-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual minority (SM) individuals (gay, lesbian, bisexual, or otherwise nonheterosexual) are at increased risk for mental disorders and suicide and adequate mental healthcare may be life-saving. However, SM patients experience barriers in mental healthcare that have been attributed to the lack of SM-specific competencies and heterosexist attitudes and behaviors on the part of mental health professionals. Such barriers could have a negative impact on common treatment factors such as treatment expectancy or therapeutic alliance, culminating in poorer treatment outcomes for SM versus heterosexual patients. Actual empirical data from general psychiatric settings is lacking, however. Thus, comparing the treatment outcome of heterosexual and SM patients at risk for suicide was the primary aim of this study. The secondary aim was to compare treatment expectation and working alliance as two common factors. METHODS We report on 633 patients from a suicide prevention inpatient department within a public psychiatric hospital. Most patients were at risk for suicide due to a recent suicide attempt or warning signs for suicide, usually in the context of a severe psychiatric disorder. At least one indicator of SM status was reported by 21% of patients. We assessed the treatment outcome by calculating the quantitative change in suicide ideation, hopelessness, and depression. We also ran related treatment responder analyses. Treatment expectation and working alliance were the assessed common factors. RESULTS Contrary to the primary hypothesis, SM and heterosexual patients were comparable in their improvement in suicide ideation, hopelessness, or depression, both quantitatively and in treatment responder analysis. Contrary to the secondary hypothesis, there were no significant sexual orientation differences in treatment expectation and working alliance. When adjusting for sociodemographics, diagnosis, and length of stay, some sexual orientation differences became significant, indicating that SM patients have better outcomes. CONCLUSIONS These unexpected but positive findings may be due to common factors of therapy compensating for SM-specific competencies. It may also be due to actual presence of SM competencies - though unmeasured - in the department. Replication in other treatment settings and assessment of SM-specific competencies are needed, especially in the field of suicide prevention, before these findings can be generalized.
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Affiliation(s)
- Martin Plöderl
- Department for Crisis Intervention and Suicide Prevention, Christian Doppler Clinic, Paracelsus Medical University, Ignaz Harrerstrasse 79, A-5020, Salzburg, Austria. .,Department of Clinical Psychology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
| | - Sabine Kunrath
- 0000 0004 0523 5263grid.21604.31Department for Crisis Intervention and Suicide Prevention, Christian Doppler Clinic, Paracelsus Medical University, Ignaz Harrerstrasse 79, A-5020 Salzburg, Austria
| | - Robert J. Cramer
- 0000 0001 2164 3177grid.261368.8School of Community and Environmental Health Sciences, Old Dominion University, Norfolk, Virginia USA ,Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia USA
| | - Jen Wang
- 0000 0001 0423 4662grid.8515.9Interdisciplinary Division for Adolescent Health, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Larissa Hauer
- 0000 0004 0523 5263grid.21604.31Department for Crisis Intervention and Suicide Prevention, Christian Doppler Clinic, Paracelsus Medical University, Ignaz Harrerstrasse 79, A-5020 Salzburg, Austria
| | - Clemens Fartacek
- 0000 0004 0523 5263grid.21604.31Department for Crisis Intervention and Suicide Prevention, Christian Doppler Clinic, Paracelsus Medical University, Ignaz Harrerstrasse 79, A-5020 Salzburg, Austria ,0000 0004 0523 5263grid.21604.31Department of Clinical Psychology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
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Abstract
This article introduces a new consistent variance-based estimator called ordinal consistent partial least squares (OrdPLSc). OrdPLSc completes the family of variance-based estimators consisting of PLS, PLSc, and OrdPLS and permits to estimate structural equation models of composites and common factors if some or all indicators are measured on an ordinal categorical scale. A Monte Carlo simulation (N [Formula: see text]) with different population models shows that OrdPLSc provides almost unbiased estimates. If all constructs are modeled as common factors, OrdPLSc yields estimates close to those of its covariance-based counterpart, WLSMV, but is less efficient. If some constructs are modeled as composites, OrdPLSc is virtually without competition.
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Affiliation(s)
- Florian Schuberth
- Faculty of Business Management and Economics, University of Würzburg, Sanderring 2, 97070 Würzburg, Germany
| | - Jörg Henseler
- Faculty of Engineering Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Theo K. Dijkstra
- Faculty of Economics and Business, University of Groningen, Nettelbosje 2, P.O. Box 800, 9747 AE Groningen, The Netherlands
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26
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Magill M, Apodaca TR, Walthers J, Gaume J, Durst A, Longabaugh R, Stout RL, Carroll KM. The Alcohol Intervention Mechanisms Scale (AIMS): Preliminary Reliability and Validity of a Common Factor Observational Rating Measure. J Subst Abuse Treat 2016; 70:28-34. [PMID: 27692185 DOI: 10.1016/j.jsat.2016.07.012] [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] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 06/27/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022]
Abstract
The present work provides an overview, and pilot reliability and validity for the Alcohol Intervention Mechanisms Scale (AIMS). The AIMS measures therapist interventions that occur broadly across modalities of behavioral treatment for alcohol use disorder. It was developed based on identified commonalities in the function rather than content of therapist interventions in observed therapy sessions, as well as from existing observer rating systems. In the AIMS, the primary function areas are: explore (four behavior count codes), teach (five behavior count codes), and connect (three behavior count codes). Therapist behavior counts provide a frequency rating of occurrence (i.e., adherence). The three functions (explore, teach, connect) are then rated on global skillfulness, which provides a quality valence (i.e., competence) to the entire session. In the present study, three independent raters received roughly 30 hours of training on the use of the AIMS by the first author. Data were a sample of therapy session audio files from a Project MATCH clinical research site. Reliability results showed generally good performance for the measure. Specifically, 2-way mixed intraclass coefficients were 'excellent', ranging from .94 to .99 for function summary scores, while prevalence-adjusted, bias-adjusted kappa for global skillfulness measures were in the 'fair' to 'moderate' range (k=.36 to.40). Internal consistency reliability was acceptable, as were preliminary factor models by behavioral treatment function (i.e., explore, teach, connect). However, confirmatory fit for the subsequent three factor model was poor. In concurrent validity analyses, AIMS summary and skillfulness scores showed associations with relevant Project MATCH criterion measures (i.e., MATCH Tape Rating Scale) that were consistent with expectations. The AIMS is a promising and reliable observational measure of three proposed common functions of behavioral alcohol treatment.
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Affiliation(s)
- M Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
| | - Timothy R Apodaca
- Children's Mercy Kansas City, USA; University of Missouri-Kansas City School of Medicine, USA
| | - Justin Walthers
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Jacques Gaume
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA; Lausanne University Hospital, Lausanne, Switzerland
| | - Ayla Durst
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Richard Longabaugh
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Robert L Stout
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA; Pacific Institute for Research and Evaluation, Providence, RI, USA
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Gumz A, Kästner D, Raczka KA, Weigel A, Osen B, Rose M, Meyer B, Wollburg E, Voderholzer U, Karacic M, Vettorazzi E, Löwe B. Aggregating factors of the change process in the treatment of anorexia nervosa. Eat Behav 2015. [PMID: 26202211 DOI: 10.1016/j.eatbeh.2015.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Indexed: 11/19/2022]
Abstract
PURPOSE We aimed to reduce the large body of factors which may be associated with the change process in treatments for Anorexia Nervosa (AN) into a clinically and scientifically useful number of higher-rank dimensions. In addition, we examined the associations between the identified factors and eating disorder psychopathology and body mass index (BMI) in exploratory analyses. METHODS Within a naturalistic multicenter study we administered the Change Process Questionnaire (CPQ-AN) to inpatients with AN upon admission. The factorial structure of the CPQ-AN was explored via factor analysis. Multiple regression analyses were performed to examine the associations with BMI and eating disorder symptomatology (EDI-2). RESULTS In total 233 female inpatients with AN (mean BMI=14.9 kg/m(2), SD=1.7) participated. The factor analysis yielded four latent factors: basic need satisfaction, AN-specific cognitions and behavior, emotional involvement and commitment to treatment, and alliance and treatment confidence. Furthermore, greater basic need satisfaction and less AN-specific cognitions and behavior predicted lower EDI-2 scores. Higher alliance and treatment confidence were associated with higher BMI as well as a lower EDI-2 score. CONCLUSION The associations between the newly derived dimensions and BMI and AN-psychopathology provide evidence to support the clinical relevance of the identified change process dimensions. Future investigations could provide further insights to deepen our understanding of the change process in AN.
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Affiliation(s)
- Antje Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, and Schön Clinic Hamburg Eilbek, Hamburg, Germany.
| | - Denise Kästner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, and Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | - Karolina A Raczka
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, and Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, and Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | | | - Matthias Rose
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, and Schön Clinic Hamburg Eilbek, Hamburg, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Charité, Berlin, Germany
| | - Björn Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, and Schön Clinic Hamburg Eilbek, Hamburg, Germany; Department of Psychology, City University, London, UK
| | - Eileen Wollburg
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, and Schön Clinic Hamburg Eilbek, Hamburg, Germany; The Pennsylvania State University, Altoona, USA
| | - Ulrich Voderholzer
- Schön Clinic Roseneck Prien, Germany; Department of Psychiatry and Psychotherapy, University Hospital Freiburg, Germany
| | - Matislava Karacic
- Schön Clinic Roseneck Prien, Germany; Department of Psychiatry and Psychotherapy, University Hospital Freiburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, and Schön Clinic Hamburg Eilbek, Hamburg, Germany
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Abstract
The common factors have a long history in the field of psychotherapy theory, research and practice. To understand the evidence supporting them as important therapeutic elements, the contextual model of psychotherapy is outlined. Then the evidence, primarily from meta-analyses, is presented for particular common factors, including alliance, empathy, expectations, cultural adaptation, and therapist differences. Then the evidence for four factors related to specificity, including treatment differences, specific ingredients, adherence, and competence, is presented. The evidence supports the conclusion that the common factors are important for producing the benefits of psychotherapy.
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Affiliation(s)
- Bruce E Wampold
- Department of Counseling Psychology, University of WisconsinMadison, WI, USA
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Affiliation(s)
- William R Miller
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, NM, USA
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Hartmann-Boyce J. Specific versus relational factors in addiction treatment: the forest and the trees, or just more trees? Addiction 2015; 110:417-8. [PMID: 25678291 DOI: 10.1111/add.12814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/19/2014] [Indexed: 12/01/2022]
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Miller WR, Moyers TB. The forest and the trees: relational and specific factors in addiction treatment. Addiction 2015; 110:401-13. [PMID: 25066309 DOI: 10.1111/add.12693] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [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: 05/01/2014] [Revised: 06/09/2014] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Abstract
AIMS Increased expectations for the use of evidence-based methods in addiction treatment have fueled a debate regarding the relative importance of 'specific' versus 'common' factors in treatment outcome. This review explores the influence of these factors on addiction treatment outcome. METHODS The authors review and link findings from four decades of research on specific and general factors in addiction treatment outcome research. FINDINGS Although few would argue that what one does in addiction treatment is immaterial, outcome studies tend to find small to no difference when specific treatment methods are compared with each other or with treatment as usual. In contrast, there are usually substantial differences among therapists in client outcomes, and relational factors such as therapist empathy and therapeutic alliance can be significant determinants of addiction treatment outcome. CONCLUSIONS In addiction treatment, relational factors such as empathy, which are often described as common, non-specific factors, should not be dismissed as 'common' because they vary substantially across providers and it is unclear how common they actually are. Similarly they should not be relegated to 'non-specific' status, because such important relational influences can be specified and incorporated into clinical research and training.
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Affiliation(s)
- William R Miller
- Department of Psychology and Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico, USA
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