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Wen X, Gou M, Chen H, Kishimoto T, Qian M, Margraf J, Berger T. The Efficacy of Web-Based Cognitive Behavioral Therapy With a Shame-Specific Intervention for Social Anxiety Disorder: Randomized Controlled Trial. JMIR Ment Health 2024; 11:e50535. [PMID: 39115189 PMCID: PMC11331269 DOI: 10.2196/50535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 03/29/2024] [Accepted: 05/25/2024] [Indexed: 08/21/2024] Open
Abstract
Background Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and generally co-occurs with elevated shame levels. Previous shame-specific interventions could significantly improve outcomes in social anxiety treatments. Recent review suggests that integrating a more direct shame intervention could potentially increase the effectiveness of cognitive behavioral therapy. Web-based cognitive behavioral therapy (WCBT) has proven efficacy, sustaining benefits for 6 months to 4 years. Previous evidence indicated that shame predicted the reduction of social anxiety and mediated between engagements in exposure and changes in social anxiety during WCBT. Objective This study aimed to design a shame intervention component through a longitudinal study and conduct a randomized controlled trial to investigate the effectiveness of a shame intervention component in reducing social anxiety symptoms and shame experience in a clinical sample of people with SAD. Methods The development of a shame intervention component was informed by cognitive behavioral principles and insights from longitudinal data that measured the Experience of Shame Scale (ESS), the Coping Styles Questionnaire, and the Social Interaction Anxiety Scale (SIAS) in 153 participants. The psychoeducation, cognitive construct, and exposure sections were tailored to focus more on shame-related problem-solving and self-blame. A total of 1220 participants were recruited to complete questionnaires, including the ESS, the SIAS, the Social Phobia Scale (SPS), and diagnostic interviews. Following a 2-round screening process, 201 participants with SAD were randomly assigned into a shame WCBT group, a normal WCBT group, and a waiting group. After the 8-week WCBT intervention, the participants were asked to complete posttest evaluations, including the ESS, SIAS and SPS. Results Participants in the shame WCBT group experienced significant reductions in shame levels after the intervention (ESS: P<.001; ηp2=0.22), and the reduction was greater in the shame intervention group compared to normal WCBT (P<.001; mean deviation -12.50). Participants in both the shame WCBT and normal WCBT groups experienced significant reductions in social anxiety symptoms (SIAS: P<.001; ηp2=0.32; SPS: P<.001; ηp2=0.19) compared to the waiting group after intervention. Furthermore, in the experience of social interaction anxiety (SIAS), the shame WCBT group showed a higher reduction compared to the normal WCBT group (P<.001; mean deviation -9.58). Problem-solving (SE 0.049, 95% CI 0.025-0.217) and self-blame (SE 0.082, 95% CI 0.024-0.339) mediated the effect between ESS and SIAS. Conclusions This is the first study to design and incorporate a shame intervention component in WCBT and to validate its efficacy via a randomized controlled trial. The shame WCBT group showed a significant reduction in both shame and social anxiety after treatment compared to the normal WCBT and waiting groups. Problem-solving and self-blame mediated the effect of shame on social anxiety. In conclusion, this study supports previous findings that a direct shame-specific intervention component could enhance the efficacy of WCBT.
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Affiliation(s)
- Xu Wen
- Department of Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
- School of Psychological and Cognitive Science, Peking University, Beijing, China
| | - Mengke Gou
- School of Psychological and Cognitive Science, Peking University, Beijing, China
| | - Huijing Chen
- School of Sociology and Political Science, Shanghai University, Shanghai, China
| | - Tomoko Kishimoto
- Department of Social Psychology, Nankai University School of Sociology, Tianjin, China
| | - Mingyi Qian
- School of Psychological and Cognitive Science, Peking University, Beijing, China
| | - Jürgen Margraf
- Department of Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
| | - Thomas Berger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
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2
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Franken K, ten Klooster P, Bohlmeijer E, Westerhof G, Kraiss J. Predicting non-improvement of symptoms in daily mental healthcare practice using routinely collected patient-level data: a machine learning approach. Front Psychiatry 2023; 14:1236551. [PMID: 37817829 PMCID: PMC10560743 DOI: 10.3389/fpsyt.2023.1236551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives Anxiety and mood disorders greatly affect the quality of life for individuals worldwide. A substantial proportion of patients do not sufficiently improve during evidence-based treatments in mental healthcare. It remains challenging to predict which patients will or will not benefit. Moreover, the limited research available on predictors of treatment outcomes comes from efficacy RCTs with strict selection criteria which may limit generalizability to a real-world context. The current study evaluates the performance of different machine learning (ML) models in predicting non-improvement in an observational sample of patients treated in routine specialized mental healthcare. Methods In the current longitudinal exploratory prediction study diagnosis-related, sociodemographic, clinical and routinely collected patient-reported quantitative outcome measures were acquired during treatment as usual of 755 patients with a primary anxiety, depressive, obsessive compulsive or trauma-related disorder in a specialized outpatient mental healthcare center. ML algorithms were trained to predict non-response (< 0.5 standard deviation improvement) in symptomatic distress 6 months after baseline. Different models were trained, including models with and without early change scores in psychopathology and well-being and models with a trimmed set of predictor variables. Performance of trained models was evaluated in a hold-out sample (30%) as a proxy for unseen data. Results ML models without early change scores performed poorly in predicting six-month non-response in the hold-out sample with Area Under the Curves (AUCs) < 0.63. Including early change scores slightly improved the models' performance (AUC range: 0.68-0.73). Computationally-intensive ML models did not significantly outperform logistic regression (AUC: 0.69). Reduced prediction models performed similar to the full prediction models in both the models without (AUC: 0.58-0.62 vs. 0.58-0.63) and models with early change scores (AUC: 0.69-0.73 vs. 0.68-0.71). Across different ML algorithms, early change scores in psychopathology and well-being consistently emerged as important predictors for non-improvement. Conclusion Accurately predicting treatment outcomes in a mental healthcare context remains challenging. While advanced ML algorithms offer flexibility, they showed limited additional value compared to traditional logistic regression in this study. The current study confirmed the importance of taking early change scores in both psychopathology and well-being into account for predicting longer-term outcomes in symptomatic distress.
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Affiliation(s)
- Katinka Franken
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
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Barnett P, Oshinowo I, Cooper C, Taylor C, Smith S, Pilling S. The association between social class and the impact of treatment for mental health problems: a systematic review and narrative synthesis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:581-603. [PMID: 36418643 PMCID: PMC10066076 DOI: 10.1007/s00127-022-02378-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 10/28/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This systematic review aimed to synthesise all quantitative literature on the association between social class and the effectiveness of interventions for mental health disorders. METHODS Systematic literature searches (inception-March 2021) were conducted across 7 databases, and all quantitative studies meeting inclusion criteria, examining the impact of social class on access to treatment, or intervention effectiveness, or the impact of treatment on social mobility, were synthesised narratively. RESULTS Evidence suggests that lower social class may be associated with reduced access to primary and secondary mental health care and increased likelihood of access via crisis services, and patients of lower social class may not benefit from all mental health interventions, with reduced effectiveness. While limited, there was some indication that psychosocial interventions could encourage increased employment rates. CONCLUSION Social class is associated with the effectiveness of psychological interventions, and should be considered when designing new interventions to prevent barriers to access and improve effectiveness.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK.
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
| | - Iyinoluwa Oshinowo
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Christopher Cooper
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
| | - Clare Taylor
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Shubulade Smith
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Rennick-Egglestone S, Newby C, Robinson C, Yeo C, Ng F, Elliott R, Ali Y, Llewellyn-Beardsley J, Pomberth S, Harrison J, Gavan SP, Cuijpers P, Priebe S, Hall C, Slade M. Differences between online trial participants who have used statutory mental health services and who have not: analysis of baseline data from two pragmatic trials of a digital health intervention (Preprint). J Med Internet Res 2022. [DOI: 10.2196/44687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
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5
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Sæther SMM, Knapstad M, Grey N, Smith ORF. Moderators of treatment effect of Prompt Mental Health Care compared to treatment as usual: Results from a randomized controlled trial. Behav Res Ther 2022; 158:104198. [PMID: 36122439 DOI: 10.1016/j.brat.2022.104198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND In this exploratory study, we investigated a comprehensive set of potential moderators of response to the primary care service Prompt Mental Health Care (PMHC). METHODS Data from an RCT of PMHC (n = 463) versus treatment as usual (TAU, n = 215) were used. At baseline mean age was 34.8, 66.7% were women, and 91% scored above caseness for depression (PHQ-9) and 87% for anxiety (GAD-7). OUTCOMES change in symptoms of depression and anxiety and change in remission status from baseline to six- and 12- months follow-up. Potential moderators: sociodemographic, lifestyle, social, and cognitive variables, variables related to (mental) health problem and care. Each moderator was examined in generalized linear mixed models with robust maximum likelihood estimation. RESULTS Effect modification was only identified for anxiolytic medication for change in symptoms of depression and anxiety; clients using anxiolytic medication showed less effect of PMHC relative to TAU (all p < 0.001), although this result should be interpreted with caution due to the low number of anxiolytic users in the sample. For remission status, none of the included variables moderated the effect of treatment. CONCLUSION As a treatment for depression and/or anxiety, PMHC mostly seems to work equally well as compared to TAU across a comprehensive set of potential moderators.
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Affiliation(s)
- Solbjørg M M Sæther
- Department of Health Promotion, Norwegian Institute of Public Health, Postboks 973 Sentrum, 5808, Bergen, Norway.
| | - Marit Knapstad
- Department of Health Promotion, Norwegian Institute of Public Health, Postboks 973 Sentrum, 5808, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Postboks 7807 5020, Bergen, Norway.
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Swandean, Arundel Road, Worthing, West Sussex, BN13 3EP, United Kingdom; School of Psychology, University of Sussex, Pevensey 1 Building, University of Sussex, Falmer, BN1 9QH, United Kingdom.
| | - Otto R F Smith
- Department of Health Promotion, Norwegian Institute of Public Health, Postboks 973 Sentrum, 5808, Bergen, Norway; Centre for Evaluation of Public Health Measure, Norwegian Institute of Public Health, Bergen, Norway.
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6
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Can we predict who will benefit from cognitive-behavioural therapy? A systematic review and meta-analysis of machine learning studies. Clin Psychol Rev 2022; 97:102193. [DOI: 10.1016/j.cpr.2022.102193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/29/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022]
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7
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Now I Always have to Perform Well! Effects of CBT for Social Anxiety Disorder on Negative Interpretations of Positive Social Events. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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8
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What the future holds: Machine learning to predict successful psychotherapy. Behav Res Ther 2022; 156:104116. [DOI: 10.1016/j.brat.2022.104116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 04/18/2022] [Accepted: 05/06/2022] [Indexed: 12/14/2022]
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9
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Bindung als Prädiktor von Strukturveränderungen im Verlauf von stationärer Psychotherapie. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2022; 68:6-23. [DOI: 10.13109/zptm.2022.68.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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The Nature, Timing, and Symptom Trajectories of Dropout From Transdiagnostic and Single-Diagnosis Cognitive-Behavioral Therapy for Anxiety Disorders. Behav Ther 2021; 52:1364-1376. [PMID: 34656192 PMCID: PMC8531532 DOI: 10.1016/j.beth.2021.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022]
Abstract
Dropout from psychotherapy is common and can have negative effects for patients, providers, and researchers. A better understanding of when and why patients stop treatment early, as well as actionable factors contributing to dropout, has the potential to prevent it. Here, we examined dropout from a large randomized controlled trial of transdiagnostic versus single-diagnosis cognitive-behavioral treatment (CBT) for patients with anxiety disorders (n = 179; Barlow et al., 2017). We aimed to characterize the timing of and reasons for dropout and test whether participants who dropped out had different symptom trajectories than those who completed treatment. Results indicated that overall, the greatest risk of dropout was prior to the first treatment session. In single-diagnosis CBT, dropout risk was particularly elevated before the first session and after other early sessions, whereas in transdiagnostic CBT, dropout risk was low and stable before and during treatment. Participants most often dropped out due to failure to comply with study procedures or dissatisfaction with or desiring alternative treatment. Results from multilevel models showed that trajectories of anxiety symptoms did not significantly differ between dropouts and completers. These findings suggest that there may be specific time windows for targeted and timely interventions to prevent dropout from CBT.
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11
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Swee MB, Hudson CC, Heimberg RG. Examining the relationship between shame and social anxiety disorder: A systematic review. Clin Psychol Rev 2021; 90:102088. [PMID: 34598054 DOI: 10.1016/j.cpr.2021.102088] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/21/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
This paper is the first systematic review of the literature on the relationship between shame and social anxiety (SA). We reviewed a total of 60 peer-reviewed empirical articles that met criteria for inclusion. We begin by summarizing literature investigating the empirical association between shame and SA and review literature on whether this association is impacted by cultural or diagnostic differences. Next, we briefly describe the updated version of Rapee and Heimberg's (1997) cognitive-behavioral model of social anxiety disorder (SAD; Heimberg, Brozovich, & Rapee, 2014) and propose how shame may interact with five processes described therein: environmental experiences, observations/images of the self, perceived negative evaluation by others, post-event cognitive processes, and behavioral manifestations of SA. We review the current literature on shame and SA as it relates to each of these domains. Thereafter, we discuss existing research on the role of shame in the treatment of SAD and the implications of the research discussed in this review. Finally, we conclude with a discussion of some key limitations in the existing literature and areas for future research.
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Affiliation(s)
- Michaela B Swee
- Department of Psychology, Temple University, 1701 North 13(th) Street, Philadelphia, PA 19122, United States.
| | - Chloe C Hudson
- Department of Psychology, Queen's University, 62 Arch Street, Humphrey Hall, Kingston, ON K7L 3N6, Canada.
| | - Richard G Heimberg
- Department of Psychology, Temple University, 1701 North 13(th) Street, Philadelphia, PA 19122, United States.
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12
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Fernández D, Vigo D, Sampson NA, Hwang I, Aguilar-Gaxiola S, Al-Hamzawi AO, Alonso J, Andrade LH, Bromet EJ, de Girolamo G, de Jonge P, Florescu S, Gureje O, Hinkov H, Hu C, Karam EG, Karam G, Kawakami N, Kiejna A, Kovess-Masfety V, Medina-Mora ME, Navarro-Mateu F, Ojagbemi A, O’Neill S, Piazza M, Posada-Villa J, Rapsey C, Williams DR, Xavier M, Ziv Y, Kessler RC, Haro JM. Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative. Psychol Med 2021; 51:2104-2116. [PMID: 32343221 PMCID: PMC8265313 DOI: 10.1017/s0033291720000884] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries. METHODS Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan-Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function. RESULTS Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care. CONCLUSIONS Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
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Affiliation(s)
- Daniel Fernández
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
- Serra Húnter fellow. Department of Statistics and Operations Research, Polytechnic University of Catalonia, Barcelona, Spain
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali O. Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
| | - Laura Helena Andrade
- Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | | | - Peter de Jonge
- Department of Developmental Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Hristo Hinkov
- National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Andrzej Kiejna
- Wroclaw Medical University; University of Lower Silesia, Wroclaw, Poland
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | | | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Akin Ojagbemi
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Siobhan O’Neill
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | | | - Jose Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Charlene Rapsey
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Miguel Xavier
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Yuval Ziv
- Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Josep M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
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13
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Interpersonal Patterns in Social Anxiety Disorder: Predictors and Outcomes of Cognitive-Behavioral Therapy. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-020-10192-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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14
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Margraf J, Hoyer J, Fydrich T, In-Albon T, Lincoln T, Lutz W, Schlarb A, Schöttke H, Willutzki U, Velten J. The Cooperative Revolution Reaches Clinical Psychology and Psychotherapy: An Example From Germany. CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e4459. [PMID: 36397785 PMCID: PMC9667120 DOI: 10.32872/cpe.4459] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/30/2020] [Indexed: 01/20/2023] Open
Abstract
Background Psychology is at the beginning of a cooperative revolution. Traditionally, psychological research has been conducted by individual labs, limiting its scope in clinical samples and promoting replication problems. Large-scale collaborations create new opportunities for highly powered studies in this resource-intensive research area. To present the current state of a Germany-wide platform for coordinating research across university outpatient clinics for psychotherapy. Method Since 1999, over 50 such clinics were created in Germany. They represent a unique infrastructure for research, training, and clinical care. In 2013, a steering committee initiated a nationwide research platform for systematic coordination of research in these clinics (German abbreviation "KODAP"). Its main goal is to aggregate and analyze longitudinal treatment data - including patient, therapist, and treatment characteristics - across all participating clinics. Results An initial survey (100% response rate) yielded recommendations for improved integration of data collection. Pilot data from 4,504 adult (16 clinics) and 568 child and adolescent patients (7 clinics) proved feasibility of data transfer and aggregation despite different data formats. Affective, neurotic, stress, and somatoform (adults) and anxiety and behavioral (children and adolescents) disorders were most frequent; comorbidity was high. Overcoming legal, methodological, and technical challenges, a common core assessment battery was developed, and data collection started in 2018. To date, 42 clinics have joined. Conclusions KODAP shows that research collaboration across university outpatient clinics is feasible. Fulfilling the need for stronger cumulative and cooperative research in Clinical Psychology will contribute to better knowledge about mental health, a core challenge to modern societies.
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Affiliation(s)
- Jürgen Margraf
- Mental Health Research and Treatment Center,
Ruhr University Bochum,
Bochum,
Germany
| | - Jürgen Hoyer
- Clinical Psychology and Psychotherapy,
Technical University of Dresden,
Dresden,
Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu
Berlin, Berlin,
Germany
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and
Psychotherapy, University of Koblenz-Landau, Landau,
Germany
| | - Tania Lincoln
- Clinical Psychology and Psychotherapy,
Universität Hamburg,
Hamburg,
Germany
| | - Wolfgang Lutz
- Clinical Psychology and Psychotherapy,
Trier University,
Trier, Germany
| | - Angelika Schlarb
- Clinic Psychology and Psychotherapy of Children and
Adolescents, Bielefeld University,
Bielefeld,
Germany
| | - Henning Schöttke
- Clinical Psychology and Psychotherapy,
Osnabrück University,
Osnabrück,
Germany
| | - Ulrike Willutzki
- Clinical Psychology and Psychotherapy,
University Witten/Herdecke,
Witten,
Germany
| | - Julia Velten
- Mental Health Research and Treatment Center,
Ruhr University Bochum,
Bochum,
Germany
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[Psychometric evaluation of the Experiences in Close Relationships Revised German 12-item version (ECR-RD 12) in a sample of psychotherapeutic inpatients]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2021; 67:56-69. [PMID: 33565379 DOI: 10.13109/zptm.2021.67.1.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Psychometric evaluation of the Experiences in Close Relationships Revised German 12-item version (ECR-RD 12) in a sample of psychotherapeutic inpatients Objectives: The ECR-R assesses the self-description of adult attachment strategies in romantic relationships. The present study evaluates the psychometric properties of the German 12-item short version ECR-RD 12 in a large sample of patients in psychotherapeutic inpatient treatment. Method: Inpatients in psychotherapeutic treatment (N = 2231) were assessed using the ECR-RD 12 and other clinical questionnaires. Its psychometric properties and factor structure of were evaluated. Results: The psychometric properties of the short form measure were in line with the German full length version (ECR-RD). In contrast to theoretical assumptions, factor analysis suggested a three factor solution in the present sample. Discussion: The ECR-RD 12 can be recommended as a screening measure for assessing attachment styles in inpatient psychotherapeutic settings. Further studies are required to investigate the factor structure of the measure in clinical samples.
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Altmann U, Gawlytta R, Hoyer J, Leichsenring F, Leibing E, Beutel M, Willutzki U, Herpertz S, Strauss B. Typical symptom change patterns and their predictors in patients with social anxiety disorder: A latent class analysis. J Anxiety Disord 2020; 71:102200. [PMID: 32126336 DOI: 10.1016/j.janxdis.2020.102200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/08/2020] [Accepted: 02/15/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The use of trajectories and analysis of change patterns is a promising way toward better differentiation of subgroups in psychotherapy studies. Research on change patterns in social anxiety disorder (SAD) are still rare, although SAD is one of the most common mental disorders. In a secondary analysis of data from the SOPHO-NET-trial (ISRCTN53517394) this study aimed to investigate change patterns and their predictors in a sample of SAD patients. METHODS Patients with SAD (N = 357) were randomly assigned to cognitive-behavioral or psychodynamic therapy. The Liebowitz Social Anxiety Scale (LSAS) was assessed at 1st session (pre), 8th session, 15th session and at the end of treatment (post). We used latent state variables and latent class analysis for the classification of change patterns and logistic regression for the identification of different predictors. RESULTS Analyses revealed three typical patterns: (i.) responders with a high initial impairment (N = 57), (ii.) responders with a moderate initial impairment (N = 225), and (iii.) patients with a high initial impairment and no remission (N = 75). Among other significant predicators, patient´s attachment anxiety and therapeutic alliance at session eight contributed to the prediction of change patterns. DISCUSSION Psychotherapy of SAD should consider patient's attachment and focus on the establishment of a solid therapeutic alliance in an early therapy stage.
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Affiliation(s)
- Uwe Altmann
- Universitätsklinikum Jena, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, 07740 Jena Germany.
| | - Romina Gawlytta
- Universitätsklinikum Jena, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, 07740 Jena Germany.
| | - Jürgen Hoyer
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Hohe Straße 53, 01187 Dresden Germany.
| | - Falk Leichsenring
- Universitätsklinikum Giessen, Clinic of Psychosomatic and Psychotherapy, Friedrichstr. 33, 35392 Gießen Germany.
| | - Eric Leibing
- Universitätsmedizin Göttingen Clinic of Psychosomatic Medicine and Psychotherapy Von-Siebold-Str. 5, 37075 Göttingen Germany.
| | - Manfred Beutel
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, Untere Zahlbacher Strasse 8, 55131 Mainz Germany.
| | - Ulrike Willutzki
- Universität Witten/Herdecke, Department of Psychology and Psychotherapy, Alfred-Herrhausen-Straße 44, 58455 Witten Germany.
| | - Stephan Herpertz
- LWL-Universitätsklinikum der Ruhr-Universität Bochum Clinic of Psychosomatic Medicine and Psychotherapy Alexandrinenstr. 1-3, 44791 Bochum Germany.
| | - Bernhard Strauss
- Universitätsklinikum Jena, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, 07740 Jena Germany.
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Abstract
PURPOSE OF REVIEW The alternative model for personality disorders in DSM-5 and the upcoming ICD-11 stimulated an increased interest in the concept of personality functioning for the diagnosis of personality disorders. Furthermore, the impact of personality functioning on other mental disorders has become the focus of recent research efforts. The purpose of this review is to provide a comprehensive and critical study of the empirical literature on the relationship between personality functioning and anxiety disorders. RECENT FINDINGS Recent studies predominantly show a positive association of anxiety symptoms and disorders with an impairment in personality functioning. However, no evidence was found for different levels of personality functioning according to the type of anxiety disorder. Anxiety disorders can occur at all levels of personality organization. SUMMARY Anxiety disorders are associated with significant impairment in personality functioning. As the underlying personality structure is known to play a crucial role for treatment outcome, the evaluation of personality functioning should be a central part of a comprehensive diagnostic process and treatment planning in patients with anxiety disorders.
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Jimenez-Arista LE, Holzapfel J, Shanholtz CE, Tracey TJG. The Incremental Validity of the sPaCE Scale in Predicting Treatment Outcome. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2019. [DOI: 10.1080/07481756.2019.1640617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | - Terence J. G. Tracey
- Arizona State University, Tempe, AZ, USA
- University of British Columbia, Vancouver, BC, Canada
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19
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Hoferichter E, Schmidt R, Höfler M, Hoyer J, Rottstädt F, Weidner K, Noack R. Symptombezogene Subgruppen von Patienten mit agoraphobischer Angst. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2019. [DOI: 10.1026/1616-3443/a000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Bisher ist wenig über symptombezogene Teilgruppen von Patient_innen mit agoraphobischer Angst über die Betrachtung als mit oder ohne Panikstörung hinausgehend bekannt. So sind existierende Behandlungsprogramme meist nicht modularisiert und berücksichtigen die möglicherweise vorhandenen spezifischen Bedarfe kaum. Daher untersuchten wir die Frage, welche Subgruppen anhand von symptombezogenen Variablen identifiziert werden können. Methode: N = 290 Patient_innen mit SKID-Diagnose Agoraphobie mit oder ohne Panikstörung, in einer auf die Behandlung von Angststörungen spezialisierten universitären Tagesklinik, wurden anhand von Skalenwerten des Fragebogens zu angstbezogenen Kognitionen (ACQ) sowie der Panik- und Agoraphobie-Skala (PAS) mittels einer Clusteranalyse nach dem Ward-Verfahren mit anschließender k-means-Optimierung nach inhaltlicher Interpretierbarkeit gruppiert. Die Validität wurde am externen Kriterium „Therapieerfolg“ geprüft. Ergebnisse: Neben zwei Subgruppen mit sehr hoher ( n = 67) und sehr niedriger ( n = 56) Symptomausprägung auf sämtlichen Skalen, wurden zwei qualitativ-symptomatisch differentielle Subtypen identifiziert: der Typus „Körperliche Befürchtungen“ ( n = 81) und der Typus „Verhaltenskontrollverlust“ ( n = 86). Letztere zeigten keine Unterschiede im Therapieerfolg. Schlussfolgerungen: Die Identifikation spezifischer Patient_innengruppen impliziert spezifische Therapiebedarfe und -erwartungen über das Vorliegen einer Paniksymptomatik hinaus. Es zeigte sich, dass der individuellen agoraphobischen Befürchtung bei den unterschiedlichen Patient_innengruppen besondere Bedeutung zukommt, weswegen diese bei der Therapieplanung besondere Beachtung erfahren sollte.
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Affiliation(s)
- Esther Hoferichter
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Ruth Schmidt
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Michael Höfler
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
| | - Jürgen Hoyer
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
| | - Fabian Rottstädt
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Kerstin Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - René Noack
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
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20
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Asher M, Hermesh H, Gur S, Marom S, Aderka I. Do men and women arrive, stay, and respond differently to cognitive behavior group therapy for social anxiety disorder? J Anxiety Disord 2019; 64:64-70. [PMID: 31048094 DOI: 10.1016/j.janxdis.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 03/06/2019] [Accepted: 03/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Maya Asher
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel
| | - Haggai Hermesh
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel
| | - Shay Gur
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel
| | - Sofi Marom
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel
| | - Idan Aderka
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel.
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21
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Andersson E, Crowley JJ, Lindefors N, Ljótsson B, Hedman-Lagerlöf E, Boberg J, El Alaoui S, Karlsson R, Lu Y, Mattheisen M, Kähler AK, Svanborg C, Mataix-Cols D, Mattsson S, Forsell E, Kaldo V, Schalling M, Lavebratt C, Sullivan PF, Rück C. Genetics of response to cognitive behavior therapy in adults with major depression: a preliminary report. Mol Psychiatry 2019; 24:484-490. [PMID: 30410065 PMCID: PMC6477793 DOI: 10.1038/s41380-018-0289-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Major depressive disorder is heritable and a leading cause of disability. Cognitive behavior therapy is an effective treatment for major depression. By quantifying genetic risk scores based on common genetic variants, the aim of this report was to explore the utility of psychiatric and cognitive trait genetic risk scores, for predicting the response of 894 adults with major depressive disorder to cognitive behavior therapy. The participants were recruited in a psychiatric setting, and the primary outcome score was measured using the Montgomery Åsberg Depression Rating Scale-Self Rated. Single-nucleotide polymorphism genotyping arrays were used to calculate the genomic risk scores based on large genetic studies of six phenotypes: major depressive disorder, bipolar disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, intelligence, and educational attainment. Linear mixed-effect models were used to test the relationships between the six genetic risk scores and cognitive behavior therapy outcome. Our analyses yielded one significant interaction effect (B = 0.09, p < 0.001): the autism spectrum disorder genetic risk score correlated with Montgomery Åsberg Depression Rating Scale-Self Rated changes during treatment, and the higher the autism spectrum disorder genetic load, the less the depressive symptoms decreased over time. The genetic risk scores for the other psychiatric and cognitive traits were not related to depressive symptom severity or change over time. Our preliminary results indicated, as expected, that the genomics of the response of patients with major depression to cognitive behavior therapy were complex and that future efforts should aim to maximize sample size and limit subject heterogeneity in order to gain a better understanding of the use of genetic risk factors to predict treatment outcome.
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Affiliation(s)
- Evelyn Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - James J Crowley
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatric Genomics, University of North Carolina, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Nils Lindefors
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Brjánn Ljótsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Julia Boberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Samir El Alaoui
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Robert Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Manuel Mattheisen
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Biomedicine and Center for Integrated Sequencing (iSEQ), Aarhus University, Aarhus, Denmark
| | - Anna K Kähler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Svanborg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Simon Mattsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Erik Forsell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Martin Schalling
- Neurogenetics Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Catharina Lavebratt
- Neurogenetics Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Patrick F Sullivan
- Center for Psychiatric Genomics, University of North Carolina, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
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22
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Johnson SU, Hoffart A. Moderators and predictors of outcome in metacognitive and cognitive behavioural therapy for co‐morbid anxiety disorders. Clin Psychol Psychother 2019; 26:399-408. [DOI: 10.1002/cpp.2361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/18/2019] [Accepted: 02/21/2019] [Indexed: 11/06/2022]
Affiliation(s)
| | - Asle Hoffart
- Research InstituteModum Bad Psychiatric Center Vikersund Norway
- Department of PsychologyUniversity of Oslo Oslo Norway
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23
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Adams GC, Wrath AJ, Meng X. The Relationship between Adult Attachment and Mental Health Care Utilization: A Systematic Review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:651-660. [PMID: 29916269 PMCID: PMC6187440 DOI: 10.1177/0706743718779933] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Several studies have shown a relationship between individual attachment and various aspects of treatment utilization in individuals with medical problems as well as mental health disorders. This review systematically evaluates existing literature targeting the relationship between attachment and all aspects of treatment utilization, such as engagement, participation, and completion, in adults with mental health problems. METHOD A computerized search of PsycINFO, Medline, Embase, PubMed, and Healthstar and a manual search were employed. Of 5733 titles, 105 abstracts were selected. Of these, 18 studies met full inclusion criteria. The quality of studies was evaluated and scored according to 9 characteristics. RESULTS Most studies supported an association between attachment and treatment engagement and participation. In general, attachment anxiety was associated with higher engagement and participation in services while attachment avoidance was associated with less. Data regarding attachment dimensions and treatment completion were less conclusive. CONCLUSIONS The review suggests a clear relationship between attachment and stages of treatment engagement and participation in a variety of psychiatric populations and treatments. The 2 attachment dimensions appear to have opposite effects, with possible risks for either treatment over- or underutilization. Clinical implications are discussed.
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Affiliation(s)
- G. Camelia Adams
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Andrew J. Wrath
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Xiangfei Meng
- Department of Psychiatry, Douglas Institute, McGill University, Montreal, Québec
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24
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Levy KN, Kivity Y, Johnson BN, Gooch CV. Adult attachment as a predictor and moderator of psychotherapy outcome: A meta-analysis. J Clin Psychol 2018; 74:1996-2013. [DOI: 10.1002/jclp.22685] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Kenneth N. Levy
- Department of Psychology; Pennsylvania State University; University Park Pennsylvania
| | - Yogev Kivity
- Department of Psychology; Pennsylvania State University; University Park Pennsylvania
| | - Benjamin N. Johnson
- Department of Psychology; Pennsylvania State University; University Park Pennsylvania
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25
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Strand ER, Hagen R, Hjemdal O, Kennair LEO, Solem S. Metacognitive Therapy for Depression Reduces Interpersonal Problems: Results From a Randomized Controlled Trial. Front Psychol 2018; 9:1415. [PMID: 30131749 PMCID: PMC6090231 DOI: 10.3389/fpsyg.2018.01415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/20/2018] [Indexed: 11/13/2022] Open
Abstract
Interpersonal problems are significantly elevated in patients with depression. Metacognitive therapy (MCT) for depression does not address interpersonal problems but is associated with large reduction in depressive symptoms. The main aim of the current study was to explore whether MCT leads to improvements in interpersonal problems in patients with depression. The study was a waitlist controlled trial and assessments took place at pre- and post-treatment as well as 6-month follow-up. At pre-treatment, the sample had more interpersonal problems compared to samples from other studies of psychiatric outpatients. MCT was associated with large reductions in interpersonal problems. Level of interpersonal problems were not related to poorer treatment response. MCT, which does not directly target interpersonal problems, worked well for patients with depression and interpersonal problems. Future research should compare MCT with other evidence-based treatments for patients with depression and interpersonal problems.
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Affiliation(s)
- Eivind R Strand
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roger Hagen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Leif E O Kennair
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Finegan M, Firth N, Wojnarowski C, Delgadillo J. Associations between socioeconomic status and psychological therapy outcomes: A systematic review and meta-analysis. Depress Anxiety 2018; 35:560-573. [PMID: 29697880 DOI: 10.1002/da.22765] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/16/2018] [Accepted: 03/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Socioeconomic deprivation is associated with higher prevalence of mental health problems; however, the influence of socioeconomic status (SES) on psychological therapy outcomes is as yet unclear. AIM To review published evidence on the association between indicators of SES (income, education, employment, neighborhood deprivation, social position) and the outcomes of psychological interventions for depression and anxiety. METHODS Systematic review and meta-analysis of outcomes research studies published in the last 10 years. RESULTS Seventeen studies including 165,574 patients measured at least one indicator of SES and its relationship with psychological therapy outcomes. Twelve of these studies found significant relationships between SES measures and mental health outcomes. Six studies focusing on employment status offered sufficient quantitative information to conduct meta-analysis. The overall effect of employment was not significant (-0.66, confidence of interval (CI) -1.33, 0.02). A sensitivity analysis (k = 5) showed a small effect (-0.22, CI -0.36, -0.09) of employment on treatment outcomes. CONCLUSIONS There is some evidence to indicate that socioeconomic deprivation is associated with poorer treatment outcomes, although limitations of the available data warrant treating this as a preliminary conclusion.
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Affiliation(s)
- Megan Finegan
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Nick Firth
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | | | - Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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27
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Strauß B, Altmann U, Manes S, Tholl A, Koranyi S, Nolte T, Beutel ME, Wiltink J, Herpertz S, Hiller W, Hoyer J, Joraschky P, Nolting B, Ritter V, Stangier U, Willutzki U, Salzer S, Leibing E, Leichsenring F, Kirchmann H. Changes of attachment characteristics during psychotherapy of patients with social anxiety disorder: Results from the SOPHO-Net trial. PLoS One 2018. [PMID: 29518077 PMCID: PMC5843211 DOI: 10.1371/journal.pone.0192802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objectives Within a randomized controlled trial contrasting the outcome of manualized cognitive-behavioral (CBT) and short term psychodynamic therapy (PDT) compared to a waiting list condition (the SOPHO-Net trial), we set out to test whether self-reported attachment characteristics change during the treatments and if these changes differ between treatments. Research design and methods 495 patients from the SOPHO-Net trial (54.5% female, mean age 35.2 years) who were randomized to either CBT, PDT or waiting list (WL) completed the partner-related revised Experiences in Close Relationships Questionnaire (ECR-R) before and after treatment and at 6 and 12 months follow-up. The Liebowitz Social Anxiety Scale (LSAS) was administered at pre-treatment, post-treatment, and at 6-month and 1-year follow-up. ECR-R scores were first compared to a representative healthy sample (n = 2508) in order to demonstrate that the clinical sample differed significantly from the non-clinical sample with respect to attachment anxiety and avoidance. Results LSAS scores correlated significantly with both ECR-R subscales. Post-therapy, patients treated with CBT revealed significant changes in attachment anxiety and avoidance whereas patients treated with PDT showed no significant changes. Changes between post-treatment and the two follow-ups were significant in both conditions, with minimal (insignificant) differences between treatments at the 12- month follow-up. Conclusions The current study supports recent reviews of mostly naturalistic studies indicating changes in attachment as a result of psychotherapy. Although there were differences between conditions at the end of treatment, these largely disappeared during the follow-up period which is line with the other results of the SOPHO-NET trial. Trial registration Controlled-trials.com ISRCTN53517394
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Affiliation(s)
- Bernhard Strauß
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany
| | - Uwe Altmann
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany
| | - Susanne Manes
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany
| | - Anne Tholl
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany
| | - Susan Koranyi
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany
| | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stephan Herpertz
- Psychosomatic Medicine and Psychotherapy, LWL University Clinic, Bochum, Germany
| | - Wolfgang Hiller
- Clinical Psychology and Psychotherapy, Johannes Gutenberg University, Mainz, Germany
| | - Jürgen Hoyer
- Clinical Psychology and Psychotherapy, Technical University, Dresden, Germany
| | - Peter Joraschky
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital, Technical University, Dresden, Germany
| | | | - Viktoria Ritter
- Clinical Psychology and Psychotherapy, Johann Wolfgang von Goethe University, Frankfurt, Germany
| | - Ulrich Stangier
- Clinical Psychology and Psychotherapy, Johann Wolfgang von Goethe University, Frankfurt, Germany
| | - Ulrike Willutzki
- Department of Psychology and Psychotherapy, University of Witten-Herdecke, Witten-Herdecke, Germany
| | - Simone Salzer
- International Psychoanalytic University, Berlin, Germany
| | - Eric Leibing
- Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University, Göttingen, Germany
| | - Falk Leichsenring
- Psychosomatic and Psychotherapy, University Hospital Justus-Liebig-University, Giessen, Germany
| | - Helmut Kirchmann
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany
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von Glischinski M, Willutzki U, Stangier U, Hiller W, Hoyer J, Leibing E, Leichsenring F, Hirschfeld G. Liebowitz Social Anxiety Scale (LSAS): Optimal cut points for remission and response in a German sample. Clin Psychol Psychother 2018; 25:465-473. [DOI: 10.1002/cpp.2179] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | - U. Willutzki
- Department of Psychology; Witten/Herdecke University; Witten Germany
| | - U. Stangier
- Clinical Psychology and Psychotherapy; Goethe University Frankfurt; Frankfurt Germany
| | - W. Hiller
- Institute of Psychology; University of Mainz; Mainz Germany
| | - J. Hoyer
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - E. Leibing
- Center of Psychosocial Medicine; University of Goettingen; Goettingen Germany
| | - F. Leichsenring
- Clinic of Psychosomatics and Psychotherapy; Justus-Liebig-University Giessen; Giessen Germany
| | - G. Hirschfeld
- Department of Quantitative Methods; Osnabrück University of Applied Sciences; Osnabrück Germany
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Nielsen SKK, Hageman I, Petersen A, Daniel SIF, Lau M, Winding C, Wolitzky-Taylor KB, Steele H, Vangkilde S. Do emotion regulation, attentional control, and attachment style predict response to cognitive behavioral therapy for anxiety disorders? – an investigation in clinical settings. Psychother Res 2018; 29:999-1009. [DOI: 10.1080/10503307.2018.1425933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Ida Hageman
- Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Petersen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Marianne Lau
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Clas Winding
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Kate B Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California-Los Angeles, Los Angeles, CA, USA
| | - Howard Steele
- Psychology Department, New School of Social Research, New York, NY, USA
| | - Signe Vangkilde
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Zalaznik D, Weiss M, Huppert JD. Improvement in adult anxious and avoidant attachment during cognitive behavioral therapy for panic disorder. Psychother Res 2017; 29:337-353. [DOI: 10.1080/10503307.2017.1365183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Dina Zalaznik
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Weiss
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jonathan D. Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
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31
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Velten J, Margraf J, Benecke C, Berking M, In-Albon T, Tania Lincoln, Lutz W, Schlarb A, Schöttke H, Willutzki U, Jürgen Hoyer. Methodenpapier zur Koordination der Datenerhebung und -auswertung an Hochschul- und Ausbildungsambulanzen für Psychotherapie (KODAP). ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000431] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Zusammenfassung. Die Forschung an psychotherapeutischen Hochschulambulanzen (HSA) leistet einen entscheidenden Beitrag zur Behandlung von Menschen mit psychischen Störungen und zur Weiterentwicklung und wissenschaftlichen Fundierung von Psychotherapie im Kindes-, Jugend- und Erwachsenenalter. Durch das im Jahr 2013 gestartete Projekt zur Koordination der Datenerhebung und -auswertung an Forschungs- und Ausbildungsambulanzen für Psychotherapie (KODAP) sollen unter der Trägerschaft des Verbundes universitärer Ausbildungsgänge für Psychotherapie unith.ev ab 2018 jährlich relevante Daten aus den teilnehmenden HSA aggregiert und gemeinsam ausgewertet werden. Im vorliegenden Beitrag beschreiben wir die mit dem Projekt im Zusammenhang stehenden rechtlichen, methodischen und durchführungstechnischen Herausforderungen sowie den derzeitigen Stand des Kooperationsprojektes, einschließlich einer für das Jahr 2017 geplanten Pilotstudie.
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Affiliation(s)
- Julia Velten
- Ruhr-Universität Bochum, Klinische Psychologie und Psychotherapie
| | - Jürgen Margraf
- Ruhr-Universität Bochum, Klinische Psychologie und Psychotherapie
| | - Cord Benecke
- Universität Kassel, Klinische Psychologie und Psychotherapie
| | - Matthias Berking
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Klinische Psychologie und Psychotherapie
| | - Tina In-Albon
- Universität Koblenz-Landau, Klinische Psychologie und Psychotherapie des Kindes- und Jugendalters
| | - Tania Lincoln
- Universität Hamburg, Klinische Psychologie und Psychotherapie
| | - Wolfgang Lutz
- Universität Trier, Klinische Psychologie und Psychotherapie
| | - Angelika Schlarb
- Universität Bielefeld, Klinische Psychologie und Psychotherapie des Kindes- und Jugendalters
| | | | - Ulrike Willutzki
- Universität Witten / Herdecke, Klinische Psychologie und Psychotherapie
| | - Jürgen Hoyer
- Technische Universität Dresden, Klinische Psychologie und Psychotherapie
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Emotion regulation related neural predictors of cognitive behavioral therapy response in social anxiety disorder. Prog Neuropsychopharmacol Biol Psychiatry 2017; 75:106-112. [PMID: 28126372 PMCID: PMC9278876 DOI: 10.1016/j.pnpbp.2017.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/19/2016] [Accepted: 01/22/2017] [Indexed: 01/22/2023]
Abstract
Social anxiety disorder (SAD) is characterized by aberrant prefrontal activity during reappraisal, an adaptive cognitive approach aimed at downregulating the automatic response evoked by a negative event. Cognitive behavioral therapy (CBT) is first-line psychotherapy for SAD, however, many remain symptomatic after treatment indicating baseline individual differences in neurofunctional activity may factor into CBT outcome. An emotion regulation strategy practiced in CBT is cognitive restructuring, a proxy for reappraisal. Therefore, neural response during reappraisal may serve as a brain-based predictor of CBT success. Prior to 12weeks of individual CBT, 34 patients with SAD completed a validated emotion regulation task during fMRI. Task instructions included 'Reappraise,' that is, use a cognitive approach to reduce affective state to a negative image, which was contrasted with looking at a negative image ('Look'). Regression results for Reappraise (vs. Look) revealed greater reduction in symptom severity was predicted by less pre-CBT activation in the dorsolateral prefrontal cortex (DLPFC). Regarding predictive validity, DLPFC significantly classified responder status. Post-hoc analysis revealed DLPFC activity, but not demographic data, baseline clinical measures, or reappraisal-related affective state during fMRI, significantly accounted for the variance in symptom reduction. Findings indicate patients with SAD are more likely to benefit from CBT if there is less pre-treatment DLPFC recruitment, a region strongly implicated in emotion regulation. Patients with reduced baseline frontal activation when reappraising negative stimuli may be especially helped by explicit cognitive interventions. Further research is necessary to establish DLPFC as a stable brain-based marker of treatment outcome.
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Manning RPC, Dickson JM, Palmier-Claus J, Cunliffe A, Taylor PJ. A systematic review of adult attachment and social anxiety. J Affect Disord 2017; 211:44-59. [PMID: 28088057 DOI: 10.1016/j.jad.2016.12.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/10/2016] [Accepted: 12/17/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Attachment has been implicated in the development of social anxiety. Our aim was to synthesise the extant literature exploring the role of adult attachment in these disorders. METHOD Search terms relating to social anxiety and attachment were entered into MEDLINE, PsycINFO and Web of Science. Risk of bias of included studies was assessed using and adapted version of the Agency for Healthcare Research and Quality assessment tool. Eligible studies employed validated social anxiety and attachment assessments in adult clinical and analogue samples. The review included cross sectional, interventional and longitudinal research. RESULTS Of the 30 identified studies, 28 showed a positive association between attachment insecurity and social anxiety. This association was particularly strong when considering attachment anxiety. Cognitive variables and evolutionary behaviours were identified as potential mediators, concordant with psychological theory. LIMITATIONS Due to a lack of longitudinal research, the direction of effect between attachment and social anxiety variables could not be inferred. There was substantial heterogeneity in the way that attachment was conceptualised and assessed across studies. CONCLUSIONS The literature indicates that attachment style is associated with social anxiety. Clinicians may wish to consider attachment theory when working clinically with this population. In the future, it may be useful to target the processes that mediate the relationship between attachment and social anxiety.
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Affiliation(s)
- Ray P C Manning
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool L69 3GB, United Kingdom; Wigan CAMHS, Manchester Road, Higher Ince, Wigan WN2 2JA, United Kingdom.
| | - Joanne M Dickson
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool L69 3GB, United Kingdom; Psychology Department, Edith Cowan University, Australia
| | - Jasper Palmier-Claus
- The Psychosis Research Unit, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom; Division of Psychology & Mental Health, University of Manchester, Manchester, United Kingdom
| | - Alexandra Cunliffe
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool L69 3GB, United Kingdom
| | - Peter J Taylor
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool L69 3GB, United Kingdom; Division of Psychology & Mental Health, University of Manchester, Manchester, United Kingdom
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Wiltink J, Ruckes C, Hoyer J, Leichsenring F, Joraschky P, Leweke F, Pöhlmann K, Beutel ME. Transfer of manualized Short Term Psychodynamic Psychotherapy (STPP) for social anxiety disorder into clinical practice: results from a cluster-randomised controlled trial. BMC Psychiatry 2017; 17:92. [PMID: 28288592 PMCID: PMC5348808 DOI: 10.1186/s12888-017-1257-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/08/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Despite growing evidence for manualized psychodynamic treatments, there is a lack of studies on their transfer to routine practice. This is the first study to examine the effects of an additional training in manualized Short Term Psychodynamic Psychotherapy (STPP) on the outcome in routine psychotherapy for social anxiety disorder (SAD). The study is an extension to a large RCT comparing STPP to Cognitive-Behavioral Therapy of SAD. METHODS The manualized treatment was designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners were randomized to training in manualized STPP (mSTPP) vs. treatment as usual without a specific training (tauSTPP). A total of 109 patients were enrolled (105 started treatment; 75 completed at least 20 treatment sessions). Assessments were conducted pre-treatment, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 and 12 months after termination of treatment. Remission as primary outcome was defined by the Liebowitz-Social-Anxiety-Scale (LSAS) score ≤30. Secondary outcomes were response (at least 31% reduction in LSAS), treatment duration and number of sessions, changes in social anxiety (LSAS, SPAI), depression (BDI), clinical global impression (CGI), and quality of life (EQ-5D). RESULTS Remission rates of mSTPP (9%) resp. tauSTPP (16%) and also response rates of 33% resp. 28% were comparable between the two treatment approaches as well as treatment duration and number of sessions. Most of the within-group differences (baseline to 25 sessions) indicated moderate to large improvements in both treatments; within-group differences from baseline to 12 months follow-up (LSAS, SPAI, BDI, CGI) were large ranging from d = -0.605 to d = -2.937. Benefits of mSTPP were limited to single outcomes. CONCLUSIONS Findings are discussed with regard to implementation and dissemination of empirically validated treatments in psychodynamic training and practice. SAD patients with a high comorbidity of personality disorders and a long treatment history may need longer treatments. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00000570 , registered 03. March 2011.
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Affiliation(s)
- Jörg Wiltink
- Clinic of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Christian Ruckes
- grid.410607.4Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen Hoyer
- 0000 0001 2111 7257grid.4488.0Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Falk Leichsenring
- 0000 0001 2165 8627grid.8664.cDepartment of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Peter Joraschky
- 0000 0001 2111 7257grid.4488.0Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Frank Leweke
- 0000 0001 2165 8627grid.8664.cDepartment of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Karin Pöhlmann
- 0000 0001 2111 7257grid.4488.0Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Manfred E. Beutel
- grid.410607.4Clinic of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Tolin DF, Billingsley AL, Hallion LS, Diefenbach GJ. Low pre-treatment end-tidal CO 2 predicts dropout from cognitive-behavioral therapy for anxiety and related disorders. Behav Res Ther 2016; 90:32-40. [PMID: 27960095 DOI: 10.1016/j.brat.2016.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/05/2016] [Accepted: 12/06/2016] [Indexed: 11/26/2022]
Abstract
Recent clinical trial research suggests that baseline low end-tidal CO2 (ETCO2, the biological marker of hyperventilation) may predict poorer response to cognitive-behavioral therapy (CBT) for anxiety-related disorders. The present study examined the predictive value of baseline ETCO2 among patients treated for such disorders in a naturalistic clinical setting. Sixty-nine adults with a primary diagnosis of a DSM-5 anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder completed a 4-min assessment of resting ETCO2, and respiration rate (the first minute was analyzed). Lower ETCO2 was not associated with a diagnosis of panic disorder, and was associated with lower subjective distress ratings on certain measures. Baseline ETCO2 significantly predicted treatment dropout: those meeting cutoff criteria for hypocapnia were more than twice as likely to drop out of treatment, and ETCO2 significantly predicted dropout beyond other pre-treatment variables. Weekly measurement suggested that the lower-ETCO2 patients who dropped out were not responding well to treatment prior to dropout. The present results, along with previous clinical trial data, suggest that lower pre-treatment ETCO2 is a negative prognostic indicator for CBT for anxiety-related disorders. It is suggested that patients with lower ETCO2 might benefit from additional intervention that targets respiratory abnormality.
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Affiliation(s)
- David F Tolin
- The Institute of Living, United States; Yale University School of Medicine, United States.
| | | | | | - Gretchen J Diefenbach
- The Institute of Living, United States; Yale University School of Medicine, United States
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36
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Egger N, Konnopka A, Beutel ME, Herpertz S, Hiller W, Hoyer J, Salzer S, Stangier U, Strauss B, Willutzki U, Wiltink J, Leibing E, Leichsenring F, König HH. Long-term cost-effectiveness of cognitive behavioral therapy versus psychodynamic therapy in social anxiety disorder. Depress Anxiety 2016; 33:1114-1122. [PMID: 27428816 DOI: 10.1002/da.22540] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 06/12/2016] [Accepted: 06/14/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To determine the cost-effectiveness of cognitive behavioral therapy (CBT) versus psychodynamic therapy (PDT) in the treatment of social anxiety disorder after a follow-up of 30 months from a societal perspective. METHODS This analysis was conducted alongside the multicenter SOPHO-NET trial; adults with a primary diagnosis of social anxiety disorder received CBT (n = 209) or PDT (n = 207). Data on health care utilization and productivity loss were collected at baseline, after 6 months (posttreatment), and three further follow-ups to calculate direct and indirect costs. Anxiety-free days (AFDs) calculated based on remission and response were used as measure of effect. The incremental cost-effectiveness ratio (ICER) was determined. Net benefit regressions, adjusted for comorbidities and baseline differences, were applied to derive cost-effectiveness acceptability curves. RESULTS In the descriptive analysis, the unadjusted ICER favored CBT over PDT and the adjusted analysis showed that CBT's cost-effectiveness relative to PDT depends on the willingness to pay (WTP) per AFD. As baseline costs differed substantially the unadjusted estimates might be deceptive. If additional WTPs for CBT of €0, €10, and €30 were assumed, the probability of CBT being cost-effective relative to PDT was 65, 83, and 96%. Direct costs increased compared to baseline across groups, whereas indirect costs did not change significantly. Results were sensitive to considered costs. CONCLUSIONS If the society is willing to pay ≥€30 per additional AFD, CBT can be considered cost-effective, relative to PDT, with certainty. To further increase the cost-effectiveness more knowledge regarding predictors of treatment outcome seems essential.
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Affiliation(s)
- Nina Egger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Wolfgang Hiller
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Juergen Hoyer
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Simone Salzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University, Goettingen, Germany
| | - Ulrich Stangier
- Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Ulrike Willutzki
- Clinical Psychology and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Joerg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eric Leibing
- Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University, Goettingen, Germany
| | - Falk Leichsenring
- Clinic of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Beard C, Stein AT, Hearon BA, Lee J, Hsu KJ, Björgvinsson T. Predictors of Depression Treatment Response in an Intensive CBT Partial Hospital. J Clin Psychol 2016; 72:297-310. [DOI: 10.1002/jclp.22269] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/26/2015] [Accepted: 12/31/2015] [Indexed: 11/12/2022]
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Wiltink J, Hoyer J, Beutel ME, Ruckes C, Herpertz S, Joraschky P, Koranyi S, Michal M, Nolting B, Pöhlmann K, Salzer S, Strauss B, Leibing E, Leichsenring F. Do Patient Characteristics Predict Outcome of Psychodynamic Psychotherapy for Social Anxiety Disorder? PLoS One 2016; 11:e0147165. [PMID: 26785255 PMCID: PMC4718454 DOI: 10.1371/journal.pone.0147165] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/30/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT). No study has addressed which patient variables predict outcome of PDT for social anxiety disorder. RESEARCH DESIGN AND METHODS In the largest multicenter trial on psychotherapy of social anxiety (SA) to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatment. Treatment outcome was assessed based on diverse parameters such as endstate functioning, remission, response, and drop-out. The relationship between patient characteristics (demographic variables, mental co-morbidity, personality, interpersonal problems) and outcome was analysed using logistic and linear regressions. RESULTS Pre-treatment SA predicted up to 39 percent of variance of outcome. Only few additional baseline characteristics predicted better treatment outcome (namely, lower comorbidity and interpersonal problems) with a limited proportion of incremental variance (5.5 to 10 percent), while, e.g., shame, self-esteem or harm avoidance did not. CONCLUSIONS We argue that the central importance of pre-treatment symptom severity for predicting outcomes should advocate alternative treatment strategies (e.g. longer treatments, combination of psychotherapy and medication) in those who are most disturbed. Given the relatively small amount of variance explained by the other patient characteristics, process variables and patient-therapist interaction should additionally be taken into account in future research. TRIAL REGISTRATION Controlled-trials.com/ISRCTN53517394.
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Affiliation(s)
- Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen Hoyer
- Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stephan Herpertz
- Clinic of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Peter Joraschky
- Clinic for Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | - Susan Koranyi
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Björn Nolting
- Clinic of Psychosomatics and Psychotherapeutic Medicine, Esslingen, Germany
| | - Karin Pöhlmann
- Clinic for Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | - Simone Salzer
- Clinic of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University Goettingen, Goettingen, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Eric Leibing
- Clinic of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University Goettingen, Goettingen, Germany
| | - Falk Leichsenring
- Clinic of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
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Scherer A, Boecker M, Pawelzik M, Gauggel S, Forkmann T. Emotion suppression, not reappraisal, predicts psychotherapy outcome. Psychother Res 2015; 27:143-153. [DOI: 10.1080/10503307.2015.1080875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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