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Treier AK, Hautmann C, Katzmann J, Nordmann L, Pinior J, Scholz KK, Döpfner M. Treatment components in behavioral versus nondirective telephone-assisted self-help interventions for parents of children with externalizing behavior problems. J Clin Psychol 2021; 78:735-746. [PMID: 34560813 DOI: 10.1002/jclp.23255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/22/2021] [Accepted: 09/05/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study was to analyze treatment differentiation in a behavioral and a nondirective telephone-assisted self-help intervention for parents of children with externalizing behavior problems, including the development and evaluation of a rating scale. METHODS In a randomized controlled trial, 149 parents of children aged 4-11 years with externalizing behavior problems were allocated to a behavioral or a nondirective guided self-help intervention. Parents in both conditions received eight self-help booklets and ten telephone consultations. To analyze the content of the interventions, we developed the Therapist Intervention Scale (TIS). In order to evaluate the scale and analyze treatment differentiation, parent booklets and recorded telephone consultations were rated. RESULTS Item selection and scale development were based on predefined psychometric criteria. The subscales Guidance & Structures and Relationship & Emotions were developed based on exploratory factor analyses. Interrater reliability and internal consistency were found to be acceptable to excellent. Analyses of construct validity demonstrated positive correlations for corresponding and negative correlations for non-corresponding subscales of therapist ratings. Therapists and booklets in the behavioral intervention showed higher scores on the subscale Guidance & Structures, while therapists and booklets in the nondirective intervention showed higher scores on the subscale Relationship & Emotions. CONCLUSION The analyses of the TIS support its reliability and validity. The subscale Guidance & Structures contains mainly cognitive-behavioral treatment components, while the subscale Relationship & Emotions contains mainly nondirective treatment components. The implemented telephone-assisted self-help interventions demonstrated distinct treatment profiles which match their intended therapeutic approaches.
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Affiliation(s)
- Anne-Katrin Treier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christopher Hautmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Josepha Katzmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Nordmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Pinior
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kristin-Katharina Scholz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Kleinstäuber M, Allwang C, Bailer J, Berking M, Brünahl C, Erkic M, Gitzen H, Gollwitzer M, Gottschalk JM, Heider J, Hermann A, Lahmann C, Löwe B, Martin A, Rau J, Schröder A, Schwabe J, Schwarz J, Stark R, Weiss FD, Rief W. Cognitive Behaviour Therapy Complemented with Emotion Regulation Training for Patients with Persistent Physical Symptoms: A Randomised Clinical Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:287-299. [PMID: 31430755 DOI: 10.1159/000501621] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/20/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Persistent medically unexplained symptoms (MUS) are a major burden for health care. Cognitive behaviour therapy (CBT) is efficacious for patients with MUS, with small to medium effects. The current study investigates whether therapy outcomes of a CBT for MUS patients can be improved by complementing it with emotion regulation training. METHODS In a multicentre trial 255 patients with at least three persisting MUS were randomised to 20 sessions of either conventional CBT (n = 128) or CBT complemented with emotion regulation training (ENCERT; n = 127). Somatic symptom severity and secondary outcomes were assessed at pre-treatment, therapy session 8, end of therapy, and 6-month follow-up. RESULTS Linear mixed-effect models revealed medium to large effects in both study arms for almost all outcomes at the end of therapy and 6-month follow-up. ENCERT and CBT did not differ in their effect on the primary outcome (d = 0.20, 95% CI: -0.04 to 0.44). Significant time × group cross-level interactions suggested ENCERT to be of more benefit than conventional CBT for a few secondary outcomes. Moderator analyses revealed higher effects of ENCERT in patients with co-morbid mental disorders. DISCUSSION/CONCLUSIONS Current findings are based on a representative sample. Results demonstrate that both CBT and ENCERT can achieve strong effects on primary and secondary outcomes in MUS patients. Our results do not indicate that adding a training in emotion regulation skills generally improves the effect of CBT across all patients with MUS. Large effect sizes of both treatments and potential specific benefits of ENCERT for patients with co-morbid mental disorders are discussed.
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Affiliation(s)
- Maria Kleinstäuber
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany,
| | - Christine Allwang
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich Alexander University, Erlangen, Germany
| | - Christian Brünahl
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Maja Erkic
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Harald Gitzen
- School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany
| | - Mario Gollwitzer
- Department of Social Psychology, Ludwig Maximilian University, Munich, Germany
| | | | - Jens Heider
- Outpatient Clinic for Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Andrea Hermann
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Giessen, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Martin
- School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany
| | - Jörn Rau
- Coordinating Centre for Clinical Trials, Philipps University, Marburg, Germany
| | - Annette Schröder
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Johannes Schwabe
- Department of Social Psychology, Ludwig Maximilian University, Munich, Germany
| | - Jeanine Schwarz
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Giessen, Germany
| | - Frauke Dorothee Weiss
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany
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Lutz W, Clausen SA, Deisenhofer AK. Perspektiven einer evidenzbasierten und personalisierten Psychotherapie. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2019. [DOI: 10.1026/1616-3443/a000518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Der Diskurs um eine evidenz-basierte und personalisierte (bzw. „Precision“) Medizin sowie zur Umsetzung von Evaluation und Qualitätssicherung hat in den letzten Jahren auch Einfluss auf die Psychotherapieforschung genommen. Dies gilt in Bezug auf die patientenspezifische Auswahl von Behandlungen (u. a. personalisierte Vorhersagen) als auch für die dynamische Anpassung von Interventionen im Therapieverlauf (adaptive Indikation, Feedback, Problemlösetools). Fragestellung und Methode: Im Bereich der differentiellen Indikation sind mittlerweile unterschiedliche Algorithmen („machine learning“) und Netzwerkmodelle zur Vorhersage erprobt worden. Für eine empirisch gestützte adaptive Indikation bilden insbesondere die Studien zum psychometrischen Feedback sowie die Entwicklung von Problemlösetools für Risikopatient_innen die Grundlage. Ergebnisse: Diese Grundlagenforschung war die Basis für die Entwicklung eines Entscheidungssystems (Trierer Therapie Navigator, TTN) zur Vorhersage der optimalen Behandlungsstrategie und des Abbruchrisikos. Darüber hinaus enthält der TTN ein adaptives Modellierungselement des Behandlungsverlaufs. Es können damit Risikopatienten für einen Behandlungsmisserfolg identifiziert und Behandlungsoptimierungen über Problemlösetools unterstützt werden. Schlussfolgerungen: In vorliegender Arbeit werden zentrale neue Ansätze einer evidenz-basierten und personalisierten Psychotherapie zusammenfassend dargestellt sowie die Anwendung in der klinischen Praxis diskutiert.
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Abstract
Objective: Three studies were conducted to develop and validate the Gestalt Therapy Fidelity Scale (GTFS), a 21-item measure of treatment adherence for Gestalt Therapy (GT).Method: Thirty five items for possible inclusion in the GTFS were generated on the basis of a literature review. In Study 1, a Delphi methodology consulting 63 international GT experts was used to select items for the GTFS. In Study 2, six experts used the scale to rate video-based sessions of GT, and provided feedback on the usability of the scale. In Study 3, 176 participants from 18 countries used the GTFS to rate GT and not-GT video recorded sessions.Results: The Delphi study consensus method resulted in 25 items for consideration in the GTFS. The scoring system and items were subsequently revised following further feedback from experts (Study 2). The GTFS was found to significantly discriminate between GT and not-GT based sessions (Study 3): raters scored GT sessions significantly higher than not-GT sessions. High levels of internal and inter-rater reliability were found.Conclusion: The GTFS is supported as a psychometrically sound measure of treatment adherence for GT, and hence can be used to assess the degree to which therapists are administering GT.
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Affiliation(s)
- Madeleine Fogarty
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Stephen Theiler
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
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