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Moggia D, Lutz W, Brakemeier EL, Bickman L. Treatment Personalization and Precision Mental Health Care: Where are we and where do we want to go? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01407-w. [PMID: 39172281 DOI: 10.1007/s10488-024-01407-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 08/23/2024]
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Zipfel S, Lutz W, Schneider S, Schramm E, Delgadillo J, Giel KE. The Future of Enhanced Psychotherapy: Towards Precision Psychotherapy. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:230-236. [PMID: 38934154 DOI: 10.1159/000539022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Stephan Zipfel
- Department of Psychosomatic Medicine, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence in Eating Disorders (KOMET), Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
| | - Wolfgang Lutz
- German Center for Mental Health (DZPG), Tübingen, Germany
- Department of Psychology, University of Trier, Trier, Germany
| | - Silvia Schneider
- German Center for Mental Health (DZPG), Bochum, Germany
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Elisabeth Schramm
- German Center for Mental Health (DZPG), Tübingen, Germany
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Katrin E Giel
- Department of Psychosomatic Medicine, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence in Eating Disorders (KOMET), Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
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Soodla HL, Soidla K, Akkermann K. Reading tea leaves or tracking true constructs? An assessment of personality-based latent profiles in eating disorders. Front Psychiatry 2024; 15:1376565. [PMID: 38807687 PMCID: PMC11130490 DOI: 10.3389/fpsyt.2024.1376565] [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: 01/25/2024] [Accepted: 04/12/2024] [Indexed: 05/30/2024] Open
Abstract
Background Eating disorder (ED) subtyping studies have often extracted an undercontrolled, an overcontrolled and a resilient profile based on trait impulsivity and perfectionism. However, the extent to which methodological choices impact the coherence and distinctness of resulting subtypes remains unclear. Objective In this paper, we aimed to assess the robustness of these findings by extracting personality-based subtypes on a sample of ED patients (N = 221) under different analytic conditions. Methods We ran four latent profile analyses (LPA), varying the extent to which we constrained variances and covariances during model parametrization. We then performed a comparative analysis also including state ED symptom measures as indicators. Finally, we used cross-method validation via k-means clustering to further assess the robustness of our profiles. Results Our results demonstrated a four-profile model based on variances in impulsivity and perfectionism to fit the data well. Across model solutions, the profiles with the most and least state and trait disturbances were replicated most stably, while more nuanced variations in trait variables resulted in less consistent profiles. Inclusion of ED symptoms as indicator variables increased subtype differentiation and similarity across profiles. Validation cluster analyses aligned most with more restrictive LPA models. Conclusion These results suggest that ED subtypes track true constructs, since subtypes emerged method-independently. We found analytic methods to constrain the theoretical and practical conclusions that can be drawn. This underscores the importance of objective-driven analytic design and highlights its relevance in applying research findings in clinical practice.
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Affiliation(s)
- Helo Liis Soodla
- Institute of Psychology, University of Tartu, Tartu, Estonia
- Centre for Cognitive and Behavioural Therapy, Tartu, Estonia
| | - Kärol Soidla
- Institute of Psychology, University of Tartu, Tartu, Estonia
- Centre for Cognitive and Behavioural Therapy, Tartu, Estonia
| | - Kirsti Akkermann
- Institute of Psychology, University of Tartu, Tartu, Estonia
- Centre for Cognitive and Behavioural Therapy, Tartu, Estonia
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de Jong K, Douglas S, Wolpert M, Delgadillo J, Aas B, Bovendeerd B, Carlier I, Compare A, Edbrooke-Childs J, Janse P, Lutz W, Moltu C, Nordberg S, Poulsen S, Rubel JA, Schiepek G, Schilling VNLS, van Sonsbeek M, Barkham M. Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01381-3. [PMID: 38733413 DOI: 10.1007/s10488-024-01381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed.
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Affiliation(s)
- Kim de Jong
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands.
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, Nashville, TN, USA
| | - Miranda Wolpert
- Division of Psychology and Language Sciences, Department of Clinical, Education and Health Psychology, University College London, United Kingdom, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Benjamin Aas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Faculty of Psychology and Educational Sciences, LMU Munich, Munich, Germany
| | - Bram Bovendeerd
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- Dimence, Center for mental health care, Deventer, The Netherlands
| | - Ingrid Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, London, UK
| | | | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Christian Moltu
- District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway
| | - Samuel Nordberg
- Department of Behavioral Health, Reliant Medical Group, Worcester, MA, USA
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Julian A Rubel
- Institute of Psychology, University of Osnabrück, Salzburg, Austria
| | - Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Valentino K, Edler K. The next generation of developmental psychopathology research: Including broader perspectives and becoming more precise. Dev Psychopathol 2024:1-10. [PMID: 38351870 PMCID: PMC11322423 DOI: 10.1017/s0954579424000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
The current Special Issue marks a major milestone in the history of developmental psychopathology; as the final issue edited by Cicchetti, we have an opportunity to reflect on the remarkable progress of the discipline across the last four decades, as well as challenges and future directions for the field. With contemporary issues in mind, including rising rates of psychopathology, health disparities, and international conflict, as well as rapid growth and accessibility of digital and mobile technologies, the discipline of developmental psychopathology is poised to advance multidisciplinary, developmentally- and contextually- informed research, and to make substantial progress in supporting the healthy development of individuals around the world. We highlight key future directions and challenges for the next generation of developmental psychopathology research including further investigation of culture at multiple levels of analysis, incorporation of macro-level influences into developmental psychopathology research, methods advances to address heterogeneity in translational research, precision mental health, and the extension of developmental psychopathology research across the lifespan.
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Blackwell SE. Using the 'Leapfrog' Design as a Simple Form of Adaptive Platform Trial to Develop, Test, and Implement Treatment Personalization Methods in Routine Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-023-01340-4. [PMID: 38316652 DOI: 10.1007/s10488-023-01340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/07/2024]
Abstract
The route for the development, evaluation and dissemination of personalized psychological therapies is complex and challenging. In particular, the large sample sizes needed to provide adequately powered trials of newly-developed personalization approaches means that the traditional treatment development route is extremely inefficient. This paper outlines the promise of adaptive platform trials (APT) embedded within routine practice as a method to streamline development and testing of personalized psychological therapies, and close the gap to implementation in real-world settings. It focuses in particular on a recently-developed simplified APT design, the 'leapfrog' trial, illustrating via simulation how such a trial may proceed and the advantages it can bring, for example in terms of reduced sample sizes. Finally it discusses models of how such trials could be implemented in routine practice, including potential challenges and caveats, alongside a longer-term perspective on the development of personalized psychological treatments.
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Affiliation(s)
- Simon E Blackwell
- Department of Clinical Psychology and Experimental Psychopathology, Georg-Elias-Mueller-Institute of Psychology, University of Göttingen, Kurze-Geismar-Str.1, 37073, Göttingen, Germany.
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