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Janse P, Geurtzen N, Scappini A, Hutschemaekers G. Disentangling the Therapist Effect: Clustering Therapists by Using Different Treatment Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:769-779. [PMID: 38512559 PMCID: PMC11379780 DOI: 10.1007/s10488-024-01365-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
Previous studies have shown that therapists' performance varies, known as therapist effects, and have indicated that therapists who excel in one treatment outcome may not necessarily be effective in other outcomes. This observational naturalistic study aimed to enhance our understanding of therapist effects and the assessment of therapists' performance in different areas. The study included 68 therapists and 5,582 clients from a large mental health facility. Information about their learning activities was available for a subsample of 49 therapists. Separate multilevel analyses were conducted for treatment outcomes, including case mix-corrected OQ-45 change scores, dropout rates, referrals to other facilities, treatment duration, and client satisfaction ratings. A hierarchical cluster analysis was performed to identify groups of therapists based on their performance across various treatment outcomes. Additionally, differences in therapist characteristics among the clusters identified were examined. Therapist effects varied across different outcomes, ranging from small (2.6% for OQ-45 change) to moderate (6.5% for number of sessions). The cluster analysis revealed four distinct clusters of therapists with specific profiles. They had performance differences in certain areas but not in others. This exploratory study supports the notion that therapists exhibit diverse profiles regarding treatment outcomes. These findings are significant for future investigations of therapist effects that aim to identify the characteristics of effective therapists and in the context of personalizing treatment for clients.
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Affiliation(s)
| | | | - Agathe Scappini
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Giel Hutschemaekers
- Pro Persona Research, Wolfheze, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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Coyne AE, Constantino MJ, Boswell JF, Gaines AN, Kraus DR. Therapist-Level Moderators of Patient-Therapist Match Effectiveness in Community Psychotherapy. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:738-752. [PMID: 38565810 PMCID: PMC11379779 DOI: 10.1007/s10488-024-01360-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 04/04/2024]
Abstract
Based on patient-reported outcomes data analyzed at the provider level, there is evidence that psychotherapists can possess effectiveness strengths and weaknesses when treating patients with different presenting concerns. These within-therapist differences hold promise for personalizing care by prospectively matching patients to therapists' historical effectiveness strengths. In a double-masked randomized controlled trial (RCT; NCT02990000), such matching outperformed pragmatically determined usual case assignment-which leaves personalized, measurement-based matching to chance-in naturalistic outpatient psychotherapy (Constantino et al., JAMA Psychiatry 78:960-969, 2021). Demonstrating that personalization can be even more precise, some research has demonstrated that the strength of this positive match effect was moderated by certain patient characteristics. Notably, though, it could also be that matching is especially important for some therapists to achieve more effective outcomes. Examining this novel question, the present study drew on the Constantino et al. (JAMA Psychiatry 78:960-969, 2021) trial data to explore three therapist-level moderators of matching: (a) effectiveness "spread" (i.e., greater performance variability across patients' presenting problem domains), (b) overestimation of their measurement-based and problem-specific effectiveness, and (c) the frequency with which they use patient-reported routine outcomes monitoring in their practice. Patients were 206 adults, randomized to the match or control condition, treated by 40 therapists who were crossed over conditions. The therapist variables were assessed at the trial's baseline and patients' symptomatic/functional impairment and global distress were assessed regularly up to 16 weeks of treatment. Hierarchical linear models revealed that only therapist effectiveness spread significantly moderated the match effect for the global distress outcome; for therapists with more spread, the match effect was more pronounced, whereas the match effect was minimal for therapists with less effectiveness spread. Notably, two therapist-level covariates unexpectedly emerged as significant moderators for the symptomatic/functional impairment outcome; for clinicians who consistently treated patients with higher versus lower average severity levels and who relatedly treated a higher proportion of patients with primary presenting problems of substance misuse or violence, the beneficial match effect was even stronger. Thus, measurement-based matching may be especially potent for therapists with more variable effectiveness across problem domains, and who consistently treat patients with more severe presenting concerns or with particular primary problems, which provides further precision in conceptualizing personalized care.
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Affiliation(s)
- Alice E Coyne
- Department of Psychology, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA.
| | - Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - James F Boswell
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Averi N Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
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Boswell JF, Schwartzman CM, Constantino MJ, Scharff A, Muir HJ, Gaines AN, King BR, Kraus DR. A Qualitative Analysis of Stakeholder Attitudes Regarding Personalized Provider Selection and Patient-Therapist Matching. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:634-649. [PMID: 37740813 DOI: 10.1007/s10488-023-01302-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
This study explored mental health care patients and therapists' perspectives on using therapists' measurement-based and problem-specific effectiveness data to inform case assignments - a type of treatment personalization that has been shown to outperform non-measurement-based case assignment as usual (Constantino et al., 2021). We conducted semi-structured qualitative interviews with 8 patients (75% women; M age = 33.75 years) and 8 therapists (75% women; M age = 47.50 years). The interview protocols were unique to stakeholder group. Recorded responses were transcribed and qualitatively analyzed by four judges using a blend of consensual qualitative research and grounded theory methods. Derived patient domains included preferred characteristics of a provider, and experiences and suggestions regarding provider selection. Within the domains, most patients expressed an interest in accessing more specific provider information online. Additionally, most patients indicated that both provider outcome track records and personal preference information (e.g., therapist characteristics) should be considered in the therapist selection process. All patients endorsed being comfortable with having the ability to select a provider based on a list of empirically well-matched recommendations. Derived therapist domains included using routine outcomes monitoring for patient-provider matching, referral source and direct patient use of preferred provider lists, and improvements to the provider selection process. Within the domains, all therapists remarked that outcome data would be useful for matching patients to providers; however, most also indicated that outcome data should not be the only factor used in provider selection. All therapists expressed a willingness to be included in preferred provider lists that incorporate track record data. Overall, both patients and therapists held generally positive views toward using therapist effectiveness data to help personalize mental health care. Yet, both stakeholder groups acknowledged that other personalization factors should be considered alongside these data. Based on these results, our team is in the process of implementing patient-therapist match strategies in larger and more diverse mental health care contexts.
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Affiliation(s)
- James F Boswell
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA.
| | - Carly M Schwartzman
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
| | - Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Adela Scharff
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
| | - Heather J Muir
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Averi N Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Brittany R King
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
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Dat NT, Mitsui N, Asakura S, Kako Y, Takanobu K, Fujii Y, Kusumi I. Enhancing self-esteem and self-compassion to mitigate suicide risk: A feasibility and acceptability study among Japanese university students. Asian J Psychiatr 2024; 101:104207. [PMID: 39217767 DOI: 10.1016/j.ajp.2024.104207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/25/2024] [Accepted: 08/29/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Suicide is a serious mental health problem among university students. The current study aimed to examine the effectiveness of a novel intervention that targets suicide risk by enhancing self-esteem and self-compassion. METHODS Participants were recruited from the healthcare center at a Japanese University. Measurements of suicidal risk, self-compassion, self-esteem, and other psychological variables were collected at baseline, post-intervention, four-week follow-up, eight-week follow-up, and twelve-week follow-up. Participants also provided feedback on the program's acceptability. RESULTS A total of 17 participants consented to participate in the intervention, 14 completed post-treatment assessment, 10 completed the four-week follow-up assessment, and 8 completed the eight-week and twelve-week follow-up assessment. Following the intervention, the study observed moderate to large improvements in self-esteem, self-compassion, hopelessness, depression, and suicide risk. The participants also reported reliable changes in clinical outcomes and positive perceptions of the program. CONCLUSIONS The psychoeducation program exhibited high acceptability and feasibility and promising early outcomes. Despite the small sample size and lack of a control group, these findings suggest potential benefits of the program. Further studies for examining the efficacy of the program are highly warranted.
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Affiliation(s)
- Nguyen Tan Dat
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Nobuyuki Mitsui
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan; Health Care Center of Hokkaido University, Sapporo, Hokkaido, Japan.
| | - Satoshi Asakura
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan; Health Care Center of Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuki Kako
- Forensic Psychiatry Center, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Keisuke Takanobu
- Forensic Psychiatry Center, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yutaka Fujii
- Hokkaido Prefectural Koyogaoka Hospital, Abashiri, Hokkaido, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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Messina I, Trimoldi G. Shaping psychotherapy trainees' potential: insights from training program directors. RESEARCH IN PSYCHOTHERAPY (MILANO) 2024; 27. [PMID: 39221905 DOI: 10.4081/ripppo.2024.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
The role of the therapist has received growing attention in psychotherapy research, suggesting that training effectiveness may also depend on the person of the trainees, with relevant implications in terms of candidate selection or tailoring training to the person. In the present study, we focused on how and how much psychotherapy training can be effective in fostering trainees' characteristics associated with successful therapists and contrast trainees' characteristics that could represent limitations as therapists. The aim was to explore training program directors' perspectives on individual trainees' limitations and strengths, and on the effectiveness of training in shaping successful therapists. To this aim, we interviewed 14 training program directors with different psychotherapy approaches. Audio recordings of these semi-structured interviews were transcribed verbatim and analysed using NVivo software. According to our findings, transversally to different psychotherapy approaches, trainees' self-awareness and the ability to embrace uncertainty were recognized as the main characteristics of good trainees. Four training elements were fre- quently mentioned by directors as effective in shaping trainees' development: experiential learning, the use of paradigm that pri- oritizes self-awareness (instead of technique-focused approaches), the centrality of supervision and inter-vision, the trainer-trainee relationship. These insights highlight the importance of trainees' self-awareness and the ability to embrace uncertainty as potential personal variables that may influence the effectiveness of future psychotherapists and suggest giving attention to experiential learning and training relationships as crucial elements of psychotherapists' development during the training.
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Affiliation(s)
- Irene Messina
- Department of Humanities and Social Sciences, Universitas Mercatorum, Rome.
| | - Giovanna Trimoldi
- Department of Humanities and Social Sciences, Universitas Mercatorum, Rome.
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James K, Saxon D, Barkham M. Transforming the Effectiveness and Equity of a Psychological Therapy Service: A Case Study in the English NHS Talking Therapies Program. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01403-0. [PMID: 39153042 DOI: 10.1007/s10488-024-01403-0] [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: 07/24/2024] [Indexed: 08/19/2024]
Abstract
To work with a psychological therapies service to implement a recovery plan, as required by a government body, aimed at improving patient outcomes (effectiveness) and decreasing practitioner variability (equity). A case-study utilizing components of a learning health system, including nationally mandated patient outcome data, comprising three 18-month phases: (1) retrospective baseline; (2) improving patient outcomes (management-led); and (3) reducing practitioner variability (clinician-led). Primary analyses focused on 35 practitioners (NPR = 35) who were constant across the three phases and their patients in each phase (NPA = 930, 1226, 1217, respectively). Reliable improvement rates determined patient outcomes and multilevel modeling yielded practitioner effects. To test generalizability, results were compared to the whole practitioner sample for each phase: (1) NPR = 81, NPA = 1982; (2) NPR = 80, NPA = 2227; (3) NPR = 74, NPA = 2267. Ethical approval was granted by the Health Research Authority. Patient outcomes improved in successive phases for both the core and whole practitioner samples with the largest impact occurring in the management-led intervention. Practitioner variability decreased in successive phases in both the core and whole practitioner samples except in the management-led intervention of the whole sample. Compared with the management-led intervention, the practitioner-led intervention yielded a decrease in practitioner effect exceeding 60% in the core sample and approaching 50% in the whole sample. The implementation of multiple components of a learning health system can lead to improvements in both the effectiveness and equity of a psychological therapy service.
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Affiliation(s)
- Katy James
- Department of Psychology, University of Sheffield, Norfolk and Suffolk NHS Foundation Trust, Vita Health Group, Sheffield, England
| | - David Saxon
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, 1 Vicar Lane, Sheffield, S1 2LT, England.
| | - Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, 1 Vicar Lane, Sheffield, S1 2LT, England
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Lakey B. Evidence that specific personal relationships help regulate depressive symptoms and related constructs among people with probable major depressive disorder. ANXIETY, STRESS, AND COPING 2024:1-15. [PMID: 39119883 DOI: 10.1080/10615806.2024.2388843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 07/18/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION Relational regulation theory describes how social network members (providers of regulation) help people (recipients of regulation) regulate their effect, actions and thoughts through mostly ordinary social interaction. Regulation is relational when the ability of a provider to regulate a recipient is an emergent property of the dyad and not a stable property of the provider or recipient. Research in predominantly well samples has found that dyads evoked affect and self-relevant thought in recipients. The present research examined whether such effects occurred among people with probable major depressive disorder (MDD). METHODS A national, internet sample of 2058 US residents was screened for probable MDD. Depressed recipients (N = 152) rated their experience of depression-related constructs when with or thinking about specific providers. RESULTS Recipients' reports of affect and thought varied strongly depending on the dyad they were with or thinking about. These effects occurred for depressive symptoms, positive and negative affect, self-esteem, negative automatic thoughts, hopelessness, excessive reassurance-seeking, reappraisal and emotion suppression. Dyads that evoked depression-related experiences were seen by participants as unsupportive and as evoking conflict. CONCLUSION Relational regulation appears to occur among people with MDD which provides new insights about interpersonal processes in depression.
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Affiliation(s)
- Brian Lakey
- Department of Psychology, Grand Valley State University, Allendale, MI, USA
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Gumz A, Longley M, Franken F, Janning B, Hosoya G, Derwahl L, Kästner D. Who are the skilled therapists? Associations between personal characteristics and interpersonal skills of future psychotherapists. Psychother Res 2024; 34:817-827. [PMID: 37723119 DOI: 10.1080/10503307.2023.2259072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE Facilitative interpersonal skills (FIS) are a promising variable to explain the so-called therapist effect. We aimed to investigate associations between observer-rated interpersonal skills and self-reported personal characteristics of future therapists. METHOD In this cross-sectional observational study, psychology students and trainee therapists completed self-report personality and sociodemographic questionnaires as well as the FIS Performance Task (German version, observer-rated). Mixed multilevel model analysis was conducted with FIS total mean score (mean value of 312 individual ratings [13 video-clips, 8 FIS-items, 3 raters]) as dependent variable, therapist ID and FIS clip ID as random effects and 15 therapist variables as fixed effects. RESULTS In the present sample consisting of 177 participants (age: M = 29.8 years (SD = 7.3), [18,59]; 79.1% female, 20.9% male) greater therapists' experience level, male gender and lower levels of alexithymia were predictive for higher FIS score when statistically controlling for other therapist variables in the model. Age, self-reported childhood maltreatment, attachment style, emotion regulation and self-concept variables turned out to be unrelated. CONCLUSION The results can inform psychotherapy training programs. They specifically support the importance of addressing therapists' potential difficulties in recognizing and verbalizing emotions. This is in line with theoretical literature on alliance ruptures and premises of the Alliance-focused training.
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Affiliation(s)
- Antje Gumz
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Merle Longley
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Fabian Franken
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Bernd Janning
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Georg Hosoya
- Department of Psychological Methodology, Psychologische Hochschule Berlin, Berlin, Germany
| | - Leonie Derwahl
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Denise Kästner
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
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Deisenhofer AK, Hehlmann MI, Rubel JA, Lutz W, Schwartz B, Bräscher AK, Christiansen H, Fehm L, Glombiewski JA, Heider J, Helbig-Lang S, Hermann A, Hoyer J, In-Albon T, Lincoln T, Margraf J, Risch AK, Schöttke H, Schulze L, Stark R, Teismann T, Velten J, Willutzki U, Wilz G, Witthöft M, Odyniec P. Love yourself as a therapist, doubt yourself as an institution? Therapist and institution effects on outcome, treatment length, and dropout. Psychother Res 2024:1-14. [PMID: 38831579 DOI: 10.1080/10503307.2024.2352749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Research suggests that some therapists achieve better outcomes than others. However, an overlooked area of study is how institution differences impact patient outcomes independent of therapist variance. This study aimed to examine the role of institution and therapist differences in adult outpatient psychotherapy. METHOD The study included 1428 patients who were treated by 196 therapists at 10 clinics. Two- and three-level hierarchical linear regression models were employed to investigate the effects of therapists and institutions on three dependent patient variables: (1) symptom change, (2) treatment duration, and (3) dropout. Level three explanatory variables were tested. RESULTS The results showed that therapist effects (TE) were significant for all three types of treatment outcome (7.8%-18.2%). When a third level (institution) was added to the model, the differences between therapists decreased, and significant institution effects (IE) were found: 6.3% for symptom change, 10.6% for treatment duration, and 6.5% for dropout. The exploratory analyses found no predictors able to explain the systematic variation at the institution level. DISCUSSION TE on psychotherapy outcomes remain a relevant factor but may have been overestimated in previous studies due to not properly distinguishing them from differences at the institution level.
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Affiliation(s)
| | - Miriam I Hehlmann
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Julian A Rubel
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Wolfgang Lutz
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany
| | - Brian Schwartz
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
- Child and Adolescent Psychotherapy Clinic (KJ-PAM), Marburg, Germany
- German Center for Mental Health (DZPG), Bochum-Marburg, Germany
| | - Lydia Fehm
- Center for Psychotherapy at the Insitute of Psychology (ZPHU), Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia A Glombiewski
- Clinical Psychology and Psychotherapy of Adulthood, University of Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Jens Heider
- Clinical Psychology and Psychotherapy of Adulthood, University of Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Sylvia Helbig-Lang
- Psychotherapy Training Program (PTA Hamburg) at Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Science, Universität Hamburg, Hamburg, Germany
| | - Andrea Hermann
- Psychotherapy and Systems Neuroscience, Department of Psychology, Justus Liebig University of Giessen, Giessen, Germany
| | - Jürgen Hoyer
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Tania Lincoln
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Science, Universität Hamburg, Hamburg, Germany
| | - Jürgen Margraf
- Child and Adolescent Psychotherapy Clinic (KJ-PAM), Marburg, Germany
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Anne Katrin Risch
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Henning Schöttke
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Lars Schulze
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Rudolf Stark
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Tobias Teismann
- Mental Health Treatment and Research Center, Ruhr-University Bochum, Bochum, Germany
| | - Julia Velten
- Faculty of Psychology, Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
| | - Ulrike Willutzki
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Michael Witthöft
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Patrizia Odyniec
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
- Department of Psychology, University of Kassel, Kassel, Germany
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Haug IM, Neumer SP, Handegård BH, Lisøy C, Rasmussen LMP, Bania EV, Adolfsen F, Patras J. Dose-Response Effects of MittEcho, a Measurement Feedback System, in an Indicated Mental Health Intervention for Children in Municipal and School Services in Norway. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01389-9. [PMID: 38809322 DOI: 10.1007/s10488-024-01389-9] [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: 05/11/2024] [Indexed: 05/30/2024]
Abstract
Including routine client feedback can increase the effectiveness of mental health interventions for children, especially when implemented as intended. Rate of implementation, or dose, of such feedback interventions has been shown to moderate results in some studies. Variation in implementation and use of client feedback may also contribute to the mixed results observed within the feedback literature. This study evaluates dose-response associations of client feedback using a novel Measurement Feedback System (MFS) within an indicated group intervention. The primary aim was to determine whether the rate of MFS implementation predicts symptom reduction in anxiety and depression among school-aged children. The secondary aim was to assess whether the rate of MFS implementation influences children's satisfaction with the group intervention or their dropout rates. Data were collected via a randomized factorial study (clinicaltrials.gov NCT04263558) across 58 primary schools in Norway. Children aged 8 to 12 years (N = 701) participated in a group-based, transdiagnostic intervention targeting elevated symptoms of anxiety or depression. Half of the child groups also received the feedback intervention using the MittEcho MFS. Group leaders (N = 83), recruited locally, facilitated the interventions. The MFS dose was measured using the Implementation Index, which combines the use of MFS by both children and providers (group leaders) into a single dose variable. Results showed no significant additional effect of dose of MFS on change in depression or anxiety scores, on user satisfaction with the intervention or on intervention dropout. The discussion addresses potential reasons for these non-significant findings and implications for MFS implementation in preventive, group-based interventions in school settings.
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Affiliation(s)
- Ida Mari Haug
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway.
| | - Simon-Peter Neumer
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Bjørn Helge Handegård
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Carina Lisøy
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Lene-Mari P Rasmussen
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Elisabeth Valmyr Bania
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frode Adolfsen
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Joshua Patras
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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Lehtovuori P, Lindfors O, Tolvanen A, Heinonen E. Development of the Psychotherapist Character Virtues (PCV) Interview. Psychother Res 2024:1-20. [PMID: 38776452 DOI: 10.1080/10503307.2024.2352735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/27/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE To develop an interview-based rating method for assessing therapists' beneficial character traits and evaluate its reliability and validity. METHOD The semi-structured Psychotherapist Character Virtues (PCV) interview and evaluation method, based on Erik Erikson's and Heinz Kohut's writings on 16 virtues or abilities and achievements of an adult self, was administered to 68 psychodynamic and solution-focused therapists. Inter-rater reliability was assessed based on 20 videorecorded interviews, rated by two evaluators. In a mixed-methods design, validity was investigated against (i) therapist's questionnaire-based self-reported professional and personal background characteristics and (ii) a qualitative content analysis of emotional atmosphere in the interview. RESULTS Interrater reliability for individual 16 virtues was acceptable (median correlation .72). From individual virtues, three principal components (Creative Will, Empathy, and Love/Care) emerged with good/excellent internal consistency (component determinacies .95, .85, and .90, respectively) and criterion validity with self-reported professional and personal characteristics. Cluster analysis of therapists' component scores yielded six different therapist character profiles. In qualitative analysis, character profiles meaningfully differed in their impact on the interview's emotional atmosphere. CONCLUSION PCV appears promising for evaluating therapists' character virtues, posited to undergird therapists' sensitive attunement and responsiveness. Further research is needed on PCV's predictive validity for therapeutic relationships and outcomes.
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Affiliation(s)
| | - Olavi Lindfors
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Asko Tolvanen
- Methodology Centre for Human Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Erkki Heinonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychology, University of Oslo, Oslo, Norway
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12
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McAleavey AA, de Jong K, Nissen-Lie HA, Boswell JF, Moltu C, Lutz W. Routine Outcome Monitoring and Clinical Feedback in Psychotherapy: Recent Advances and Future Directions. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:291-305. [PMID: 38329643 PMCID: PMC11076375 DOI: 10.1007/s10488-024-01351-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
In the past decade, there has been an increase in research related to the routine collection and active use of standardized patient data in psychotherapy. Research has increasingly focused on personalization of care to patients, clinical skills and interventions that modulate treatment outcomes, and implementation strategies, all of which appear to enhance the beneficial effects of ROM and feedback. In this article, we summarize trends and recent advances in the research on this topic and identify several essential directions for the field in the short to medium term. We anticipate a broadening of research from the focus on average effects to greater specificity around what kinds of feedback, provided at what time, to which individuals, in what settings, are most beneficial. We also propose that the field needs to focus on issues of health equity, ensuring that ROM can be a vehicle for increased wellbeing for those who need it most. The complexity of mental healthcare systems means that there may be multiple viable measurement solutions with varying costs and benefits to diverse stakeholders in different treatment contexts, and research is needed to identify the most influential components in each of these contexts.
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Affiliation(s)
- Andrew A McAleavey
- Helse Førde Hospital Trust, Svanehaugvegen 2, Førde, 6812, Norway.
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway.
- Department of Psychiatry, Weill Cornell Medical Center, New York, NY, USA.
| | - Kim de Jong
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
| | | | - James F Boswell
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Christian Moltu
- Helse Førde Hospital Trust, Svanehaugvegen 2, Førde, 6812, Norway
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
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van Thiel SJ, de Jong K, Misset KS, Joosen MCW, van der Klink JJL, Vermunt JK, van Dam A. Determining differences between therapists using an extended version of the facilitative interpersonal skills performance test. J Clin Psychol 2024. [PMID: 38588045 DOI: 10.1002/jclp.23687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/05/2023] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES The therapist-facilitative interpersonal skills (FIS) has shown to predict therapy outcomes, demonstrating that high FIS therapists are more effective than low FIS therapists. There is a need for more insight into the variability in strengths and weaknesses in therapist skills. This study investigates whether a revised and extended FIS-scoring leads to more differentiation in measuring therapists' interpersonal skills. Furthermore, we explorative examine whether subgroups of therapists can be distinguished in terms of differences in their interpersonal responses. METHOD Using secondary data analysis, 93 therapists were exposed to seven FIS-clips. Responses of therapists using the original and the extended FIS scoring were rated. RESULTS Three factors were found on the extended FIS scoring distinguishing supportive, expressive, and persuasive interpersonal responses of therapists. A latent profile analysis enlightened the presence of six subgroups of therapists. CONCLUSION Using the revised and extended FIS-scoring contributes to our understanding of the role of interpersonal skills in the therapeutic setting by unraveling the question what works for whom.
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Affiliation(s)
- Sabine J van Thiel
- Tilburg School of Social and Behavioral Sciences, Tranzo-Academic Collaborative Center Work & Health, Tilburg University, Tilburg, The Netherlands
- Mental Health Institute GGZ WNB, Bergen op Zoom, The Netherlands
| | - Kim de Jong
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Kirsten S Misset
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Margot C W Joosen
- Tilburg School of Social and Behavioral Sciences, Tranzo-Academic Collaborative Center Work & Health, Tilburg University, Tilburg, The Netherlands
| | - Jac J L van der Klink
- Tilburg School of Social and Behavioral Sciences, Tranzo-Academic Collaborative Center Work & Health, Tilburg University, Tilburg, The Netherlands
- Optentia, North West University of South Africa, Potchefstroom, South Africa
| | - Jeroen K Vermunt
- Tilburg School of Social and Behavioral Sciences, Tranzo-Academic Collaborative Center Work & Health, Tilburg University, Tilburg, The Netherlands
| | - Arno van Dam
- Tilburg School of Social and Behavioral Sciences, Tranzo-Academic Collaborative Center Work & Health, Tilburg University, Tilburg, The Netherlands
- Mental Health Institute GGZ WNB, Bergen op Zoom, The Netherlands
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14
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Khan I, Taylor SJC, Robinson C, Moschopoulou E, McCrone P, Bourke L, Thaha M, Bhui K, Rosario D, Ridge D, Donovan S, Korszun A, Little P, Morgan A, Quentin O, Roylance R, White P, Chalder T. Study protocol for a pragmatic randomised controlled trial of comparing enhanced acceptance and commitment therapy plus (+) added to usual aftercare versus usual aftercare only, in patients living with or beyond cancer: SUrvivors' Rehabilitation Evaluation after CANcer (SURECAN) trial. Trials 2024; 25:228. [PMID: 38566197 PMCID: PMC10985882 DOI: 10.1186/s13063-024-08062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Two million people in the UK are living with or beyond cancer and a third of them report poor quality of life (QoL) due to problems such as fatigue, fear of cancer recurrence, and concerns about returning to work. We aimed to develop and evaluate an intervention based on acceptance and commitment therapy (ACT), suited to address the concerns of cancer survivors and in improving their QoL. We also recognise the importance of exercise and vocational activity on QoL and therefore will integrate options for physical activity and return to work/vocational support, thus ACT Plus (+). METHODS We will conduct a multi-centre, pragmatic, theory driven, randomised controlled trial. We will assess whether ACT+ including usual aftercare (intervention) is more effective and cost-effective than usual aftercare alone (control). The primary outcome is QoL of participants living with or beyond cancer measured using the Functional Assessment of Cancer Therapy: General scale (FACT-G) at 52 weeks. We will recruit 344 participants identified from secondary care sites who have completed hospital-based treatment for cancer with curative intent, with low QoL (determined by the FACT-G) and randomise with an allocation ratio of 1:1 to the intervention or control. The intervention (ACT+) will be delivered by NHS Talking Therapies, specialist services, and cancer charities. The intervention consists of up to eight sessions at weekly or fortnightly intervals using different modalities of delivery to suit individual needs, i.e. face-to-face sessions, over the phone or skype. DISCUSSION To date, there have been no robust trials reporting both clinical and cost-effectiveness of an ACT based intervention for people with low QoL after curative cancer treatment in the UK. We will provide high quality evidence of the effectiveness and cost-effectiveness of adding ACT+ to usual aftercare provided by the NHS. If shown to be effective and cost-effective then commissioners, providers and cancer charities will know how to improve QoL in cancer survivors and their families. TRIAL REGISTRATION ISRCTN: ISRCTN67900293 . Registered on 09 December 2019. All items from the World Health Organization Trial Registration Data Set for this protocol can be found in Additional file 2 Table S1.
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Affiliation(s)
- Imran Khan
- Barts and the London Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Stephanie J C Taylor
- Barts and the London Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Clare Robinson
- Barts and the London Pragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Elisavet Moschopoulou
- Barts and the London Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Liam Bourke
- Dept. Allied Health Professionals, Sheffield Hallam University, Sheffield, UK
| | - Mohamed Thaha
- Blizard Institute, Queen Mary University of London, London, UK
| | - Kamaldeep Bhui
- Nuffield Department of Primary Care Health Sciences, Wadham College, University of Oxford, Oxford, UK
| | - Derek Rosario
- The Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Damien Ridge
- School of Social Sciences, University of Westminster, New Cavendish St, London, UK
| | - Sheila Donovan
- Barts and the London Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Ania Korszun
- The Barts and the London Unit for Psychological Medicine, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Paul Little
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Adrienne Morgan
- Independent Cancer Patient's Voice (ICPV), 17 Woodbridge Street, London, UK
| | - Olivier Quentin
- Barts and the London Pragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Rebecca Roylance
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Peter White
- The Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, DeCrespigny Park, London, UK
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Ko SJ, Kim K, Kaptchuk TJ, Napadow V, Kuo B, Gerber J, Ha NY, Lee J, Kelley JM, Park JW, Kim J. Influence of patient-clinician relationship style on acupuncture outcomes in functional dyspepsia: A multi-site randomized controlled trial in Korea. PATIENT EDUCATION AND COUNSELING 2024; 121:108133. [PMID: 38199174 DOI: 10.1016/j.pec.2023.108133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Research suggests that a warm and empathic "patient-centered" patient-clinician relationship produces better clinical outcomes when compared with a more neutral "disease-centered" relationship. Acupuncturists performed both styles of therapy for patients with functional dyspepsia in Korea. METHODS The present randomized controlled trial assigned patients (n = 73) to identical acupuncture treatment with either patient-centered augmented care or disease-centered limited care. The Korean version of the Nepean Dyspepsia Index (NDI-K) was the primary outcome measure. Secondary outcome measures included Consultation And Relational Empathy (CARE) scale. RESULTS Both groups showed improvement in NDI-K. Patient-centered augmented acupuncture produced less effective symptom improvement compared to disease-centered limited acupuncture (NDI-K sum score and frequency; P = 0.008 and P = 0.037 respectively). CARE scores were higher for the augmented versus limited group (P = 0.001), supporting the fidelity of the experimentally controlled patient/clinician relationship. There were no significant differences between the groups in any of other secondary outcomes. CONCLUSION Patients demonstrated greater improvement following acupuncture conducted with a more neutral, "disease-centered" style of relationship. This result is counter to similar research conducted in Western countries and suggests that cultural factors can significantly shape optimum styles of acupuncture therapy. PRACTICE IMPLICATIONS Clinicians should consider cultural differences when applying acupuncture therapy.
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Affiliation(s)
- Seok-Jae Ko
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Keumji Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Vitaly Napadow
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Network, Harvard Medical School, Boston, MA, USA
| | - Braden Kuo
- Gastroenterology Unit, Center for Neurointestinal Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Gerber
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Na-Yeon Ha
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Junhee Lee
- Department of Sasang Constitutional Medicine, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - John M Kelley
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Psychology Department, Endicott College, Beverly, MA, USA
| | - Jae-Woo Park
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea.
| | - Jinsung Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea.
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Meyer K, Schoofs N, Hildebrandt A, Bermpohl F, Priebe K. What to think or how to think - is symptom reduction in posttraumatic symptomatology associated with change in posttraumatic cognitions or perseverative thinking? A latent change score model approach. Psychother Res 2024:1-16. [PMID: 38412334 DOI: 10.1080/10503307.2024.2316009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE Patients with posttraumatic stress disorder (PTSD) report changes in what they think of the world and themselves, referred to as posttraumatic cognitions, and changes in how they think, reflected in increased perseverative thinking. We investigated whether pre-post therapy changes in the two aspects of thinking were associated with pre-post therapy changes in posttraumatic symptom severity. METHOD 219 d clinic patients with posttraumatic stress symptoms received trauma-focused psychotherapy with cognitive behavioral and metacognitive elements. The posttraumatic cognitions inventory (PTCI), the perseverative thinking questionnaire (PTQ), and the Davidson trauma scale (DTS) were applied at two occasions, pre- and post-therapy. Using latent change score models, we investigated whether change in PTCI and change in PTQ were associated with change in DTS and its subscales. We then compared the predictive value of PTQ and PTCI in joint models. RESULTS When jointly modeled, change in overall DTS score was associated with change in both PTCI and PTQ. Concerning DTS subscales, reexperiencing and avoidance were significantly associated with change in PTCI, but not in PTQ. CONCLUSION Results indicate that both aspects of cognition may be valuable targets of psychotherapy. A focus on posttraumatic cognitions might be called for in patients with severe reexperiencing and avoidance.
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Affiliation(s)
- Kristina Meyer
- Department of Psychiatry and Neurosciences, Psychiatric University Clinic of the Charité at St. Hedwig-Hospital, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nikola Schoofs
- Department of Psychiatry and Neurosciences, Psychiatric University Clinic of the Charité at St. Hedwig-Hospital, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Hildebrandt
- Department of Psychology, Psychological Methods and Statistics, Carl von Ossietzky Universität Oldenburg, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neurosciences, Psychiatric University Clinic of the Charité at St. Hedwig-Hospital, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kathlen Priebe
- Department of Psychiatry and Neurosciences, Psychiatric University Clinic of the Charité at St. Hedwig-Hospital, Charité Universitätsmedizin Berlin, Berlin, Germany
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Esposito G, Di Maro A, Passeggia R. The relationship between treatment integrity and outcome in group psychotherapy: A systematic review. Clin Psychol Psychother 2024. [PMID: 38217388 DOI: 10.1002/cpp.2952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/15/2024]
Abstract
Treatment integrity is defined as the extent to which the treatment has been implemented according to a specific theoretical model. It consists of two components: adherence, that is, the degree to which the therapist implements the techniques prescribed by the theoretical model, and competence, that is, the degree to which the therapist skilfully and appropriately implements the techniques prescribed by the model. Recently, the issue of integrity is gaining increasing importance in psychotherapy research, especially in an attempt to clarify its role in influencing the effectiveness of treatments. However, most studies focus on the individual setting. Therefore, this systematic review aims at investigating the relationship between integrity and outcome in group clinical treatments. Results highlighted a positive relationship between group treatment integrity and outcome. Moreover, this review provided insights for implications for research, clinical practice, and training of therapists, identifying questions that still need to be answered and tracing possible future research directions.
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Affiliation(s)
- Giovanna Esposito
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Angela Di Maro
- Department of Humanities, University of Naples Federico II, Naples, Italy
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Fisher H, Stone SJ, Zilcha-Mano S, Goldstein P, Anderson T. Integrating exploration and prediction in computational psychotherapy science: proof of concept. Front Psychiatry 2024; 14:1274764. [PMID: 38283895 PMCID: PMC10811256 DOI: 10.3389/fpsyt.2023.1274764] [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: 08/08/2023] [Accepted: 12/15/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Psychotherapy research has long preferred explanatory over predictive models. As a result, psychotherapy research is currently limited in the variability that can be accounted for in the process and outcome of treatment. The present study is a proof-of-concept approach to psychotherapy science that uses a datadriven approach to achieve robust predictions of the process and outcome of treatment. Methods A trial including 65 therapeutic dyads was designed to enable an adequate level of variability in therapist characteristics, overcoming the common problem of restricted range. A mixed-model, data-driven approach with cross-validation machine learning algorithms was used to predict treatment outcome and alliance (within- and between-clients; client- and therapist-rated alliance). Results and discussion Based on baseline predictors only, the models explained 52.8% of the variance for out-of-sample prediction in treatment outcome, and 24.1-52.8% in therapeutic alliance. The identified predictors were consistent with previous findings and point to directions for future investigation. Although limited by its sample size, this study serves as proof of the great potential of the presented approach to produce robust predictions regarding the process and outcome of treatment, offering a potential solution to problems such as p-hacking and lack of replicability. Findings should be replicated using larger samples and distinct populations and settings.
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Affiliation(s)
- Hadar Fisher
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Suzannah J. Stone
- Department of Psychology, Ohio University, Athens, OH, United States
| | | | - Pavel Goldstein
- Integrative Pain Laboratory (iPainLab), School of Public Health, University of Haifa, Haifa, Israel
| | - Timothy Anderson
- Department of Psychology, Ohio University, Athens, OH, United States
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Röhrig B, Witthöft M, Herpertz S, Petrak F. "The early bird catches the worm"-Prediction of early response and its importance for treatment outcome in a naturalistic setting of cognitive behaviour therapy. Clin Psychol Psychother 2024; 31:e2956. [PMID: 38363023 DOI: 10.1002/cpp.2956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Knowledge about predictors of early response (ER) remains limited. This study examined patient, process, and therapist variables to predict ER in a naturalistic setting. RESEARCH DESIGN AND METHODS Data from 493 psychotherapy outpatients were analysed. ER was defined by a ≥25% reduction in general psychological distress (ER percent) and by the reliable change index (ER RCI) within the first 10 sessions measured by the Brief Symptom Inventory-18. ER prediction was determined using logistic regression. General psychological distress (GSI) throughout treatment in patients with and without ER was modelled using a multilevel linear model. This model aimed to predict GSI over treatment using repeated measurements, considering group affiliation (ER percent vs. no ER percent), controlled for other predictors. RESULTS The prevalence of ER percent and ER RCI were 63.6% and 47.5%, respectively. GSI and therapeutic relationship significantly predicted ER (ER percent: χ2 (6) 70.32, p < .001, Nagelkerkes R2 = .19; ER RCI: χ2 (6) 134.71, p < .001, Nagelkerkes R2 = .35). Patients who rated the therapeutic relationship more positively were more likely to achieve ER (OR = 1.10). Difference in outcomes between patients with and without ER during treatment was influenced by factors such as therapeutic relationship, GSI, therapist experience, and mental comorbidities. Including these variables improved the predictive model from AIC = 17,042.98 to AIC = 16,730.24. CONCLUSION The therapeutic relationship is a crucial predictor of ER. Patients achieving ER tend to have better outcome than those without ER. The early phase of therapy warrants particular attention to enhance psychotherapy outcomes.
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Affiliation(s)
- Bonnie Röhrig
- Center for Psychotherapy Wiesbaden MVZ GmbH, Wiesbaden, Germany
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Frank Petrak
- Center for Psychotherapy Wiesbaden MVZ GmbH, Wiesbaden, Germany
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany
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20
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Casari L, Areas M, Ison M, Gómez B, Roussos A, Consoli A, Gómez Penedo JM. Therapist's effect on children's therapeutic alliance: A naturalistic study. J Clin Psychol 2024; 80:207-222. [PMID: 37837638 DOI: 10.1002/jclp.23606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/11/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES The therapeutic alliance (TA) has been shown to be a predictor of psychotherapy treatment success. In the case of psychotherapy with children, there is a dearth of information on TA's role. The aims of the paper are: (1) To estimate the therapist effects on children TA; (2) to investigate if therapists' TA predicts children's TA; (3) to analyze if children's age and sex predict children's TA; (4) to evaluate if the therapist's characteristics predict children's TA. METHODS The sample consisted of 77 children undergoing psychotherapy in Argentina, and the therapists (N = 29) providing services to those children. The assessment tools utilized for the study included the Therapy Alliance Scale for Children and the Personal Style of the Therapist Questionnaire (PST-Q). RESULTS Findings indicated that 2% of the children's TA was explained by the therapists (ICC = 0.02), while 17% of the therapists' TA was explained by the therapists (ICC = 0.17). Therapists' TA predicted children's TA. Children's age and sex did not have an effect on their own TA. Moreover, therapists with more experience achieved higher scores of children's TA. Finally, the Operative dimension of the PST had a negative effect on children's TA (i.e., therapists who prefer more spontaneous interventions over structured ones may experience higher levels of therapeutic alliance with child patients). CONCLUSION We found a positive effect of the therapist's TA on children's TA, especially in the preference for using more spontaneous intervention techniques. We discuss the implications of the findings on the training of psychotherapists who provide services to children.
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Affiliation(s)
- Leandro Casari
- INCIHUSA, CONICET, Mendoza, Argentina
- Facultad de Humanidades y Ciencias Económicas, Pontificia Universidad Católica Argentina, Mendoza, Argentina
| | - Malenka Areas
- CONICET, Buenos Aires, Argentina
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Andrés Roussos
- IPEHCS, Universidad del Comahue/ CONICET, Bariloche, Argentina
| | - Andrés Consoli
- University of California, Santa Barbara, California, USA
| | - Juan Martín Gómez Penedo
- CONICET, Buenos Aires, Argentina
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
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Hildebrand-Burke C, Davey C, Gwini S, Catania L, Kazantzis N. Therapist competence, homework engagement, and client characteristics in CBT for youth depression: A study of mediation and moderation in a community-based trial. Psychother Res 2024; 34:41-53. [PMID: 37963351 DOI: 10.1080/10503307.2023.2267166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 09/19/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Prior studies of Cognitive Behavioral Therapy (CBT) have focused on the quantity and quality of clients' homework completion and only rarely have considered the role of therapist competence. METHODS The present study examined (a) therapist competence across the entire process of integrating homework into CBT, including the review, design, and planning of tasks; (b) homework engagement, including client appraisals of the difficulty and obstacles encountered in task completion using the Homework Rating Scale - Revised (HRS-II); (c) pre-post symptom reduction as the index of outcome; and (d) considered client factors such as suicide risk in a community-based trial for adolescent depression. Trained independent observers assessed therapist competence and engagement with homework at two consecutive sessions of CBT for N = 80 young people (Mage = 19.61, SD = 2.60). RESULTS Significant complementary mediation effects were obtained; there was an indirect mediation effect of HRS-II Beliefs (b = 1.03, SE B = 0.42, 95% BCa CI [0.35, 2.03]) and HRS-II Perceived Consequences on the Competence-Engagement relationship (b = 0.85, SE B = 0.31, 95% BCa CI [0.39, 1.61]). High levels of suicidal ideation were also shown to moderate this relationship. CONCLUSIONS The present findings contribute to the growing body of CBT process research designed to examine the complex interrelationships of client and therapist variables, in a manner that reflects the actual process of therapy, and advances beyond studies of isolated predictors of symptom change.
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Affiliation(s)
- Craig Hildebrand-Burke
- Cognitive Behavior Therapy Research Unit, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | | | - StellaMay Gwini
- Cognitive Behavior Therapy Research Unit, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Lisa Catania
- University of Melbourne, Melbourne, VIC, Australia
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit, Melbourne, VIC, Australia
- Beck Institute for Cognitive Behavior Therapy, Philadelphia, PA, USA
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Desmet K, Bracke P, Deproost E, Goossens PJJ, Vandewalle J, Vercruysse L, Beeckman D, Van Hecke A, Kinnaer LM, Verhaeghe S. Associated factors of nurse-sensitive patient outcomes: A multicentred cross-sectional study in psychiatric inpatient hospitals. J Psychiatr Ment Health Nurs 2023; 30:1231-1244. [PMID: 37409521 DOI: 10.1111/jpm.12951] [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: 10/27/2022] [Revised: 06/06/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
WHAT IS ALREADY KNOWN?: The nurse-patient relationship in mental health care is an important focus of mental health nursing theories and research. There is limited evidence about which factors influence nurse-sensitive patient outcomes of the nurse-patient relationship. This hinders the development, planning, delivering, and quality assurance of the nurse-patient relationship in nursing practice and nursing education. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our best knowledge, this is the first study to examine associations between nurse-sensitive patient outcomes of the nurse-patient relationship and a range of patient characteristics and relationship-contextual factors. In this study, we found that gender, age, hospital characteristics, nurse availability when needed, nurse contact, and nurse stimulation were associated with the scores on the nurse-sensitive patient outcome scale. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Having insight into the factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship can help nurses, nursing students, nursing management and also patients to enhance the nurse-patient relationship, trying to influence outcomes of nursing care. ABSTRACT: Introduction The lack of evidence on patient characteristics and relational-contextual factors influencing nurse-sensitive patient outcomes of a nurse-patient relationship is a possible threat to the quality and education of the nurse-patient relationship. Aim To measure nurse-sensitive patient outcomes of the nurse-patient relationship and to explore the associations between nurse-sensitive patient outcomes and a range of patient characteristics and relational-contextual factors. Method In a multicenter cross-sectional study, 340 inpatients from 30 units in five psychiatric hospitals completed the Mental Health Nurse-Sensitive Patient Outcome Scale. Descriptive, univariate and Linear Mixed Model analyses were conducted. Results Overall, patient-reported outcomes were moderate to good. Female participants, nurse availability when needed, more nurse contact and nurse stimulation were associated with higher outcomes. Age differences were observed for some of the outcomes. Outcomes also varied across hospitals but were not related to the number of times patients were hospitalized or to their current length of stay in the hospital. Discussion The results may help nurses to become more sensitive and responsive to factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship. Implications The nurse-sensitive results can support nurses in designing future nurse-patient relationships.
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Affiliation(s)
- Karel Desmet
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- AZ Damiaan, Ostend, Belgium
| | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Eddy Deproost
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Centre for Psychiatry and Psychotherapy Clinic Sint-Jozef, Pittem, Belgium
| | - Peter J J Goossens
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Dimence Mental Health Center for Bipolar Disorder, Deventer, the Netherlands
| | | | - Lieke Vercruysse
- Centre for Psychiatry and Psychotherapy Clinic Sint-Jozef, Pittem, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- School of Health Sciences, Örebro University, Örebro, Sweden
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
- Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Lise-Marie Kinnaer
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Nursing, VIVES University College, Roeselare, Belgium
- Faculty of Medicine and Life Science, University Hasselt, Hasselt, Belgium
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23
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Gori A, Topino E, Cacioppo M, Schimmenti A, Caretti V. Definition and Criteria for the Assessment of Expertise in Psychotherapy: Development of the Psychotherapy Expertise Questionnaire (PEQ). Eur J Investig Health Psychol Educ 2023; 13:2478-2497. [PMID: 37998063 PMCID: PMC10670582 DOI: 10.3390/ejihpe13110173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
Therapist expertise is a complex, multifaceted, and continually evolving concept. Defining this construct and its constituent components can yield a substantial contribution to the field of psychotherapy, consequently enhancing the comprehension of the fundamental factors that underlie its effectiveness. Within this framework, the present research aimed at developing and assessing the psychometric properties of the Psychotherapy Expertise Questionnaire (PEQ), a self-report measure to assess therapist expertise. A sample of 260 psychotherapists of various theoretical orientations were involved in this research. They completed a survey that included the PEQ as well as other self-reported measures aimed at evaluating personality traits, self-efficacy, self-esteem, and insight orientation. The analysis provided evidence of a good fit for both a correlational model with eight factors and a higher-order model, where the eight subdimensions were grouped into subjective (performance; cognitive functioning; personal and relational qualities of the therapist; therapist self-assessment) and objective (experience; reputation with clients and colleagues; training and professional updating; deontological ethics and setting rules) factors. The eight dimensions, two higher-order factors, and total score all showed excellent levels of internal consistency. Furthermore, significant associations were found between PEQ scores and insight orientation, general self-efficacy, self-esteem, personality traits, and time exercising clinical practice. To conclude, the Psychotherapy Expertise Questionnaire (PEQ) is a valuable, theoretically guided, and psychometrically robust self-report measure designed to assess therapist expertise and its constitutive dimensions. This measure can have practical applications in guiding tailored training and customised supervision.
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Affiliation(s)
- Alessio Gori
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Florence, Italy
- Integrated Psychodynamic Psychotherapy Institute (IPPI), Via Ricasoli 32, 50122 Florence, Italy
| | - Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy; (E.T.); (M.C.); (V.C.)
| | - Marco Cacioppo
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy; (E.T.); (M.C.); (V.C.)
| | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE—Kore University of Enna, Cittadella Universitaria, 94100 Enna, Italy;
| | - Vincenzo Caretti
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy; (E.T.); (M.C.); (V.C.)
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Pfund RA, Ginley MK, Kim HS, Boness CL, Horn TL, Whelan JP. Cognitive-behavioral treatment for gambling harm: Umbrella review and meta-analysis. Clin Psychol Rev 2023; 105:102336. [PMID: 37717456 PMCID: PMC11059187 DOI: 10.1016/j.cpr.2023.102336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/16/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
The aim of the current umbrella review and meta-analysis was to evaluate the methodological rigor of existing meta-analyses on cognitive-behavioral treatment (CBT) for gambling harm. The Cochrane Database of Systematic Reviews, PsycINFO, and PubMed were searched for meta-analyses of CBT for gambling harm among individuals aged 18 years and older. The search yielded five meta-analyses that met inclusion criteria, representing 56 unique studies and 5389 participants. The methodological rigor for one meta-analyses was rated high, two were moderate, and two were critically low. Including only moderate- to high-quality meta-analyses, a robust variance estimation meta-analysis indicated that CBT significantly reduced gambling disorder severity (g = -0.91), gambling frequency (g = -0.52), and gambling intensity (g = -0.32) relative to minimal and no treatment control at posttreatment, suggesting 65%-82% of participants receiving CBT will show greater reductions in these outcomes than minimal or no treatment controls. Overall, there is strong evidence for CBT in reducing gambling harm and gambling behavior, and this evidence provides individuals, clinicians, managed care companies, and policymakers with clear recommendations about treatment selection.
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Affiliation(s)
- Rory A Pfund
- Tennessee Institute for Gambling Education & Research, USA; Department of Psychology, University of Memphis, USA.
| | - Meredith K Ginley
- Tennessee Institute for Gambling Education & Research, USA; Department of Psychology, East Tennessee State University, USA
| | - Hyoun S Kim
- Department of Psychology, Toronto Metropolitan University, Canada
| | - Cassandra L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, USA
| | - Tori L Horn
- Tennessee Institute for Gambling Education & Research, USA; Department of Psychology, University of Memphis, USA
| | - James P Whelan
- Tennessee Institute for Gambling Education & Research, USA; Department of Psychology, University of Memphis, USA
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25
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Bovendeerd B, de Jong K, de Groot E, Moerbeek M, Hafkenscheid A, de Keijser J. The effect of therapist characteristics on the use and outcome of systematic client feedback in outpatient mental healthcare. Clin Psychol Psychother 2023; 30:1146-1157. [PMID: 37278224 DOI: 10.1002/cpp.2873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Therapist characteristics are known to affect treatment outcome in general and could also influence the use of systematic client feedback (SCF). The current study explores the effect of feedback orientation, regulatory focus, self-efficacy, attitude towards feedback resources and perceived feedback validity on the use and outcome of SCF in outpatient mental healthcare. METHOD The data of therapists (n = 12) and patients (n = 504) of two outpatient centres offering brief psychological treatment were analysed when SCF, based on the Partners for Change Outcome Management System (PCOMS), was added to treatment as usual. The data of therapists were obtained through a therapist questionnaire composed of relevant characteristics from feedback studies in social and organizational psychology. The effect on the use of SCF was analysed using logistic regression; whereas, the effect on outcome was assessed using a two-level multilevel analysis. Regular use of SCF and the Outcome Questionnaire (OQ-45) were used as outcome variables. DSM-classification, sex and age of each patient were included as covariates. RESULTS High perceived feedback validity significantly increased the use of SCF. No significant therapist characteristics effects were found on outcome, but high promotion focus was associated with treating more complex patients. CONCLUSIONS The perceived feedback validity of SCF is likely to have an influence on its use and is probably affected by the changes in the organizational climate.
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Affiliation(s)
- Bram Bovendeerd
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- GGZ Center for Mental Health Care, Dimence, Deventer, The Netherlands
| | - Kim de Jong
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Erik de Groot
- GGZ Center for Mental Health Care, Dimence, Deventer, The Netherlands
| | - Mirjam Moerbeek
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Anton Hafkenscheid
- Arkin/Sinaï Centre, Jewish Mental Health Services, Amersfoort/Amstelveen, The Netherlands
| | - Jos de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
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Pellens H, Vanhees V, Dezutter J, Luyten P, Vanhooren S. Therapist responsiveness in the blank landscape of depression: A qualitative study among psychotherapists. Psychother Res 2023:1-17. [PMID: 37523611 DOI: 10.1080/10503307.2023.2239457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/02/2023] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE Evidence about the high burden of depression on society and the immediate environment of patients has accumulated over the past decades. Yet, empirical data about the impact of depression on the environment of psychotherapy are limited. The present study investigates the phenomenon of therapist responsiveness in the treatment of depression. Specifically, this qualitative study examines the influence of a client's severe depressive symptomatology on psychotherapists' immediate experience and reflections about interventions. METHOD The responses of 26 Flemish psychotherapists and counselors to a questionnaire with open questions and as part of a focus group were investigated by using Consensual Qualitative Research methodology. RESULTS First, experiences with a negative valence were most common in the responses of the psychotherapists and counselors. A particular negative experience, a sense of "constriction", affecting the therapist's relational, cognitive, emotional, and bodily level of experiencing, was a predominant response. Second, most psychotherapists and counselors considered a therapeutic attitude of being present for the client and the different aspects in the client's experience to be crucial, although most of them experienced difficulty in maintaining an attitude of presence. CONCLUSIONS The results of this study suggest that exploration of the different aspects of the clients' experience and working with the self-split of the client might be essential in the psychotherapeutic treatment of depressive disorder.
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Affiliation(s)
- Heidi Pellens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Valerie Vanhees
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Jessie Dezutter
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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27
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Eilertsen SEH, Eilertsen TH. Why is it so hard to identify (consistent) predictors of treatment outcome in psychotherapy? - clinical and research perspectives. BMC Psychol 2023; 11:198. [PMID: 37408027 DOI: 10.1186/s40359-023-01238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Anxiety and depression are two of the most debilitating psychological disorders worldwide today. Fortunately, effective treatments exist. However, a large proportion of patients do not recover from treatment, and many still have symptoms after completing treatment. Numerous studies have tried to identify predictors of treatment outcome. So far, researchers have found few or no consistent predictors applicable to allocate patients to relevant treatment. METHODS We set out to investigate why it is so hard to identify (consistent) predictors of treatment outcome for psychotherapy in anxiety and depression by reviewing relevant literature. RESULTS Four challenges stand out; a) the complexity of human lives, b) sample size and statistical power, c) the complexity of therapist-patient relationships, and d) the lack of consistency in study designs. Together these challenges imply there are a countless number of possible predictors. We also consider ethical implications of predictor research in psychotherapy. Finally, we consider possible solutions, including the use of machine learning, larger samples and more realistic complex predictor models. CONCLUSIONS Our paper sheds light on why it is so hard to identify consistent predictors of treatment outcome in psychotherapy and suggest ethical implications as well as possible solutions to this problem.
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Affiliation(s)
- Silje Elisabeth Hasmo Eilertsen
- Haugaland DPS/Department of Research and Innovation, Helse Fonna HF, Haugaland DPS v/ Silje Eilertsen, Postboks 2052, Haugesund, Norway.
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28
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Sousa M, Andrade J, de Castro-Rodrigues A, Gonçalves RA. The Effectiveness of Psychological Treatment in Adult Male Convicted for Sexual Offenses Against Children: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:1867-1881. [PMID: 35411837 DOI: 10.1177/15248380221082080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Child sexual abuse is a public health problem of global magnitude with profound and negative consequences for the victims and society. Thus, psychological intervention with individuals who sexually offended against children is crucial for reducing recidivism. Numerous reviews and meta-analyses have shown the effectiveness of psychological interventions in individuals who sexually offended, but few reviews have been done on this subtype of offenders. This article reviews evaluation studies of intervention programs designed to treat individuals who sexually offended against children, providing a more detailed account of treatment procedures. Articles were identified from peer-reviewed databases, bibliographies, and experts. Following full-text review, 12 studies were selected for inclusion by meeting the following criteria: quantitative or qualitative research studies published in English from 2000 to 2020 with titles or abstracts that indicated a focus on treatment effectiveness, detailing the psychological treatment procedures on adult, male individuals convicted for child sexual abuse. Cognitive-behavioral therapy with a relapse prevention approach was the most frequent modality found in child sexual offending treatment. Besides, different criminogenic and non-criminogenic factors emerge as targets for intervention. Study design, study quality, and intervention procedures shortened the accumulation of evidence in treatment effectiveness.
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Affiliation(s)
- Marta Sousa
- Psychology Research Center, University of Minho, Braga, Portugal
| | - Joana Andrade
- Psychology Research Center, University of Minho, Braga, Portugal
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29
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Janse PD, Bakker-Brehm DT, Geurtzen N, Scholing A, Hutschemaekers GJ. Therapists' self-assessment of time spent on learning activities and its relationship to treatment outcomes: A replication study. J Clin Psychol 2023; 79:1070-1081. [PMID: 36417562 DOI: 10.1002/jclp.23459] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/24/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study investigated whether therapists' self-assessed time spent on learning activities was associated with treatment outcomes. The study was a replication of Chow et al.'s (2015) study, which showed that the most effective therapists spent more total time on solitary learning activities than less effective therapists. The present study sought to replicate this finding, and it explored the association between 25 specific activities of therapists and clients' treatment outcomes. Also, this study explored which learning activities therapists found most relevant for improving their performance. METHODS In this naturalistic longitudinal study, data from 2424 outpatients who were being treated by 40 different therapists were analyzed using multilevel analyses. Posttreatment scores on the OQ-45 (controlled for pretreatment client variables) were used to measure treatment outcome. The RAPID Practice-D was used to measure therapists' learning and other activities spent with the aim of improving their therapeutic skills. RESULTS The results showed that the total amount of time that therapists indicated they spent on learning activities did not predict clients' treatment outcomes. Also, no specific learning activities were related to clients' outcomes. Nevertheless, therapists indicated that they perceived several specific activities to be highly relevant for improving their skills. CONCLUSION The results showed that therapists' perceptions of how much time they spent on learning activities was not related to their performance. This might suggest that therapists' perceptions of their activities is inaccurate or that they attach value to the wrong activities. It also indicates the importance of not relying solely on the self-assessments of therapists to evaluate a therapist's training and its relationship with outcome.
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Affiliation(s)
| | | | - Naline Geurtzen
- Pro Persona Research, Wolfheze, The Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Agnes Scholing
- Pro Persona Research, Wolfheze, The Netherlands.,Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Giel J Hutschemaekers
- Pro Persona Research, Wolfheze, The Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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Powers KE, das Nair R, Phillips J, Farrin A, Radford KA. Exploring the Association between Individual-Level Attributes and Fidelity to a Vocational Rehabilitation Intervention within a Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4694. [PMID: 36981601 PMCID: PMC10048688 DOI: 10.3390/ijerph20064694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Understanding what attributes or characteristics of those delivering interventions affect intervention fidelity and patient outcomes is important for contextualising intervention effectiveness. It may also inform implementation of interventions in future research and clinical practice. This study aimed to explore the relationships between attributes of Occupational Therapists (OTs), their faithful delivery of an early stroke specialist vocational rehabilitation intervention (ESSVR), and stroke survivor return-to-work (RTW) outcomes. Thirty-nine OTs were surveyed about their experience and knowledge of stroke and vocational rehabilitation and were trained to deliver ESSVR. ESSVR was delivered across 16 sites in England and Wales between February 2018 and November 2021. OTs received monthly mentoring to support ESSVR delivery. The amount of mentoring each OT received was recorded in OT mentoring records. Fidelity was assessed using an intervention component checklist completed using retrospective case review of one randomly selected participant per OT. Linear and logistic regression analyses explored relationships between OT attributes, fidelity, and stroke survivor RTW outcome. Fidelity scores ranged from 30.8 to 100% (Mean: 78.8%, SD: 19.2%). Only OT engagement in mentoring was significantly associated with fidelity (b = 0.29, 95% CI = 0.05-0.53, p < 0.05). Increased fidelity (OR = 1.06, 95% CI = 1.01-1.1, p = 0.01) and increasing years of stroke rehabilitation experience (OR = 1.17, 95% CI = 1.02-1.35) was significantly associated with positive stroke survivor RTW outcomes. Findings of this study suggest that mentoring OTs may increase fidelity of delivery of ESSVR, which may also be associated with positive stroke survivor return-to-work outcomes. The results also suggest that OTs with more experience of stroke rehabilitation may be able to support stroke survivors to RTW more effectively. Upskilling OTs to deliver complex interventions, such as ESSVR, in clinical trials may require mentoring support in addition to training to ensure fidelity.
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Affiliation(s)
- Katie E. Powers
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Roshan das Nair
- Health Division, SINTEF, 7465 Trondheim, Norway
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Julie Phillips
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | - Kathryn A. Radford
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
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31
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Fagerbakk SA, Sørhøy SH, Nilsen T, Laugen NJ. Does clinical training improve mentalization skills in future therapists? A comparison of first and last year students of clinical psychology and of engineering. Front Psychol 2023; 14:1066154. [PMID: 36755673 PMCID: PMC9900102 DOI: 10.3389/fpsyg.2023.1066154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
Objective Mentalization has been suggested as a therapist skill that might be important for therapeutic success. The aim of this study was to explore whether the mentalization capacity of students of clinical psychology differs from other students, and whether last-year students differ from first-year students. Method A total of 297 students participated in this study, recruited from first and last years of psychology and engineering study programs. All participants filled out the MentS, a self-report measure of mentalization capacity. Results No significant differences were found in self-reported mentalization capacity between first and last year students of clinical psychology. The results did however show that first year students of psychology had significantly higher self-reported mentalization skills compared to students of engineering, and higher MentS-scores were associated with gender (female) and higher age. Conclusion The finding that students of clinical psychology rate themselves as having a higher capacity to mentalize compared to students of engineering might suggest that individuals with a higher capacity to mentalize are more likely to engage in clinical psychology and become therapists. However, the lack of significant difference in self-reported mentalization capacity in last year students of clinical psychology compared to first year students might indicate that the Norwegian education in clinical psychology does not succeed in enhancing mentalization in future therapists. Clinical psychology study programs might benefit from targeted mentalization training.
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Wolfer C, Hilpert P, Flückiger C. Therapist Interpersonal Behavior: An Investigation of Various Constructs and Underlying Abilities. VERHALTENSTHERAPIE 2023. [DOI: 10.1159/000526953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
<b><i>Objective:</i></b> Psychotherapists differ in their treatment effectiveness as measured by the therapy outcome of their patients. One possible factor for therapist effects seems to be the therapists’ interpersonal skills. Therapist assessments of interpersonal skills have demonstrated sufficient predictive validity, but little is known about underlying skills and related constructs. The purpose of the present study is to compare the different constructs of interpersonal skills with each other and to investigate possible underlying abilities. <b><i>Study Population and Methods:</i></b> In this exploratory study, the concept of interpersonal skills was investigated using three survey methods (questionnaires, computer tests, and assessments) and comparing two measurements each. For this purpose, 6 measures of interpersonal skills were collected from 20 prospective psychotherapists as well as 28 psychology students (total <i>N</i> = 48). Alongside more traditional methods, the correlations and overlaps of the constructs were examined using partial and Bayesian networks. <b><i>Results:</i></b> Moderate to high correlations are found within the self-report measures. The assessments, however, did not correlate with self-report measures nor with computer tests. <b><i>Discussion and Conclusion:</i></b> The similarities in the self-assessments indicate stable self-concepts of interpersonal skills, which, however, cannot be explained by the underlying skills nor by the observer-based evaluations. The marginal correlation between the assessments also indicates that interpersonal, therapy-related abilities must be interpreted in a situation-specific manner.
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Desmet K, Bracke P, Deproost E, Goossens PJJ, Vandewalle J, Vercruysse L, Beeckman D, Van Hecke A, Kinnaer LM, Verhaeghe S. Patient-reported outcomes of the nurse-patient relationship in psychiatric inpatient hospitals: A multicentred descriptive cross-sectional study. J Psychiatr Ment Health Nurs 2023; 30:568-579. [PMID: 36588478 DOI: 10.1111/jpm.12895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/08/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Psychiatric and/or mental health nurses are struggling to measure the outcomes of the nurse-patient relationship. Collecting nurse-sensitive patient outcomes is a strategy to provide outcomes of a nurse-patient relationship from patients' perspectives. Because there was no validated scale, the Mental Health Nurse-Sensitive Patient Outcome-Scale (six-point Likert-scale) was recently developed and psychometrically evaluated. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study using the Mental Health Nurse-Sensitive Patient Outcome-scale to measure nurse-sensitive patient outcomes of the nurse-patient relationship in psychiatric hospitals. Moderate to good average scores for the MH-NURSE-POS total (4.42) and domains scores (≥4.09). are observed. Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60). Our results are consistent with the patient-reported effect(s) of relation-based nursing in qualitative research. The scores generate evidence to support the outcomes of the nurse-patient relationship and implicates that further investment in (re)defining and elaborating nurse-patient relationships in mental healthcare is meaningful and justified. More comparative patient-reported data can determine how nurse-sensitive patient outcomes are affected by the patient, nurse, and context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Demonstrating patient-reported outcomes of the nurse-patient relationship can be important to enhance the therapeutic alliance between nurses and patients, organize responsive nursing care, and create nursing visibility in mental healthcare. Further nursing staff training on interpersonal competencies, such as self-awareness and cultural sensitivity, can be pivotal to achieving the patient-reported outcomes for inpatients with mental health problems. ABSTRACT INTRODUCTION: Identifying patient-reported outcomes of the nurse-patient relationship is a priority in inpatient mental healthcare to guide clinical decision-making and quality improvement initiatives. Moreover, demonstrating nurse-sensitive patient outcomes can be a strategy to avoid further erosion of the specialism of psychiatric and/or mental health nursing. AIM/QUESTION To measure nurse-sensitive patient outcomes of the nurse-patient relationship. METHOD In a multicentred cross-sectional study, 296 inpatients admitted to five psychiatric hospitals completed the recently developed and validated Mental Health Nurse-Sensitive Patient Outcome-Scale (MH-NURSE-POS). The MH-NURSE-POS consists of 21 items (six-point Likert-scale) in four domains: 'growth', 'expression', 'control', and 'motivation'. RESULTS Participants displayed moderate to good average scores for the MH-NURSE-POS total (4.42) and domain scores (≥4.09). Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60). DISCUSSION The results demonstrate that patients perceive the nurse-patient relationship and the care given by psychiatric and/or mental health nurses as contributing to their treatment. IMPLICATIONS FOR PRACTICES Patient-reported outcomes can guide nurses and managers to provide and organize nursing care and to build a nurse-patient relationship that has a positive impact on these outcomes. Additionally, outcomes can create nursing visibility as a profession in- and outside mental healthcare.
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Affiliation(s)
- Karel Desmet
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Eddy Deproost
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Centre for Psychiatry and Psychotherapy Clinic St-Joseph, Pittem, Belgium
| | - Peter J J Goossens
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Dimence Mental Health Center for Bipolar Disorder, Deventer, The Netherlands
| | | | - Lieke Vercruysse
- Centre for Psychiatry and Psychotherapy Clinic St-Joseph, Pittem, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,School of Health Sciences, Örebro University, Örebro, Sweden.,School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Lise-Marie Kinnaer
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium.,Faculty of Medicine and Life Science, University Hasselt, Hasselt, Belgium
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McEwan HE, Tod D. Trainee clinical, and sport and exercise psychologists' experiences of professional development: A longitudinal study. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 64:102343. [PMID: 37665798 DOI: 10.1016/j.psychsport.2022.102343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 09/06/2023]
Abstract
The aim of this study was to examine longitudinal professional development in distinct types of UK psychologists. We interviewed 9 trainee clinical psychologists (TCPs), and 9 sport and exercise psychologists' (TSEPs) 3 times at a minimum of yearly intervals during their 3-year (TCP) or 2-year (TSEP) training programme. Participants were registered on either the British Psychological Society (BPS) Qualification in Sport and Exercise Psychology (QSEP; Stage 2), or a doctorate in clinical psychology. We applied a reflexive thematic analysis to transcripts based on a counsellor development framework. Our findings indicate that diverse types of trainee psychologists experience similar patterns of development. Participants: (a) were developing their practice consistent with their personality; (b) experienced changes in emotions and presence during training; and (c) internal developmental processes were influenced by external sources (supervisors, and peers). Findings may help us to understand how trainees fuse their personal and professional selves during training.
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Mahon D. A scoping review of deliberate practice in the acquisition of therapeutic skills and practices. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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del Río Olvera FJ, Rodríguez-Mora Á, Senín-Calderón C, Rodríguez-Testal JF. The first session is the one that counts: An exploratory study of therapeutic alliance. Front Psychol 2022; 13:1016963. [PMID: 36507019 PMCID: PMC9732893 DOI: 10.3389/fpsyg.2022.1016963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background The controversy about whether psychotherapy outcome is the consequence of the techniques themselves, common factors or both is still current. The importance of common factors has been demonstrated, although it is also known that they alone are insufficient. At the present time, the contextual model grants heavy weight to the therapeutic alliance in the first sessions and seems to predict positive final results. Furthermore, monitoring sessions has demonstrated that this alliance improves. Objectives To analyze the relationship between the therapeutic alliance and patient's perceived improvement during the first five sessions of therapy, and find out whether the therapeutic alliance is maintained or unstable within that timeframe. Methods Thirty-four patients at a university psychological care service who had had at least five therapy sessions participated. Of these, 70.46% were women (Mage = 24.24, SD = 6.73). The patients filled out the Outcome Rating Scale and Session Rating Scale the week before each session. Data were analyzed by the Dual STATIS method. Results The compromise matrix explained 77.36% of the variability. The position of the vectors and the distribution of the position of the patients on the graph show that as their perception increased, therapeutic alliance remained stable. Moreover, the position of the vectors shows that the therapeutic alliance was forged in the first session and remained stable during the following sessions. Conclusion This exploratory study demonstrated the importance of the first session in establishing the therapeutic alliance, and for it to remain stable, regardless of whether the rest of the therapeutic process has variations or changes. Novel use of the STATIS method for analyzing measurements in the first five sessions, showed that beginning the therapeutic intervention with a strong alliance, produced the favorable, lasting effects necessary for development of the intervention.
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Affiliation(s)
- Francisco Javier del Río Olvera
- Department of Psychology, University of Cadiz, Cadiz, Spain,Institute of Biomedical Research and Innovation of Cádiz (INIBICA), University of Cadiz, Cadiz, Spain,Psychological Assistance Service, University of Cadiz, Cadiz, Spain
| | - Álvaro Rodríguez-Mora
- Department of Psychology, University of Cadiz, Cadiz, Spain,Psychological Assistance Service, University of Cadiz, Cadiz, Spain,University Institute of Research for Sustainable Social Development (NDESS), University of Cadiz, Cadiz, Spain,*Correspondence: Álvaro Rodríguez-Mora,
| | - Cristina Senín-Calderón
- Department of Psychology, University of Cadiz, Cadiz, Spain,Institute of Biomedical Research and Innovation of Cádiz (INIBICA), University of Cadiz, Cadiz, Spain,Psychological Assistance Service, University of Cadiz, Cadiz, Spain
| | - Juan F. Rodríguez-Testal
- Department of Personality, Evaluation and Psychological Treatment, University of Seville, Seville, Spain
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van Tilburg CA, van Dam A, de Wolf-Jacobs E, de Ruiter C, Smeets T. Group Cognitive-Behavioral Therapy in a Sample of Dutch Intimate Partner Violence Perpetrators: Development of a Coding Manual for Therapist Interventions. Int J Group Psychother 2022; 72:305-330. [PMID: 38446551 DOI: 10.1080/00207284.2022.2105702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This qualitative study investigated which types of interventions are made by group therapists during group cognitive-behavioral therapy (GCBT) with individuals who have perpetrated intimate partner violence (IPV) in the "Not 'Losing It' Anymore"(NLIA) outpatient programs across the Netherlands. Audio recordings of group sessions (N = 60) facilitated by 13 co-therapist teams across 25 different groups were analyzed using the general inductive approach. Fifteen distinct therapist interventions were identified, categorized, and described using examples from the data. Two categories of interventions could be distinguished: CBT interventions and process-oriented interventions. In future research the coding manual can be tested for interrater reliability and might be used in research on the effectiveness of GCBT therapist interventions.
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Grainger L, Thompson Z, Morina N, Hoppen T, Meiser‐Stedman R. Associations between therapist factors and treatment efficacy in randomized controlled trials of trauma-focused cognitive behavioral therapy for children and youth: A systematic review and meta-analysis. J Trauma Stress 2022; 35:1405-1419. [PMID: 35478465 PMCID: PMC9790492 DOI: 10.1002/jts.22840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/10/2022] [Accepted: 03/09/2022] [Indexed: 12/30/2022]
Abstract
Previous research suggests that the effect of therapist factors on patient outcomes is significant. Yet, to date, no reviews have explored the potential effects of therapist characteristics on treatment outcomes for children and youth with posttraumatic stress disorder (PTSD). This systematic review and meta-analysis aimed to summarize the professional characteristics of trial therapists delivering trauma-focused cognitive behavioral interventions (TF-CBT) for child PTSD in clinical trials and understand the association between treatment efficacy and therapist factors. Systematic searches for randomized controlled trials (RCTs) published through November 3, 2020, were conducted; 40 RCTs were included in the full review. PTSD treatment outcome data were extracted from each publication along with any available data regarding trial therapists. Subgroup analyses were conducted to compare the outcomes of interventions conducted by different types of therapists. All therapist groups yielded significant effects for TF-CBT relative to active and passive control conditions, with the largest effect size, Hedges' g = -1.11, for RCTs that used clinical psychologists and psychiatrists. A significant moderating effect was found when comparing the treatment outcomes of clinical psychologists and psychiatrists versus other professionals, p = .044; however, this effect was no longer apparent when only studies with an active control arm were included. Further moderator analyses demonstrated no significant differences regarding therapists' educational and professional backgrounds and PTSD treatment outcomes. The current RCT evidence for TF-CBT for children and youth with PTSD does not suggest that therapist educational or professional background influences treatment efficacy. Limitations and implications for future research are discussed.
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Affiliation(s)
- Lauren Grainger
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical SchoolUniversity of East AngliaNorwichUnited Kingdom
| | - Zoe Thompson
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical SchoolUniversity of East AngliaNorwichUnited Kingdom
| | | | - Thole Hoppen
- Department of PsychologyUniversity of MünsterMünsterGermany
| | - Richard Meiser‐Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical SchoolUniversity of East AngliaNorwichUnited Kingdom
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Goldberg SB. A common factors perspective on mindfulness-based interventions. NATURE REVIEWS PSYCHOLOGY 2022; 1:605-619. [PMID: 36339348 PMCID: PMC9635456 DOI: 10.1038/s44159-022-00090-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 05/25/2023]
Abstract
Mindfulness-based interventions (MBIs) have entered mainstream Western culture in the past four decades. There are now dozens of MBIs with varying degrees of empirical support and a variety of mindfulness-specific psychological mechanisms have been proposed to account for the beneficial effects of MBIs. Although it has long been acknowledged that non-specific or common factors might contribute to MBI efficacy, relatively little empirical work has directly investigated these aspects. In this Perspective, I suggest that situating MBIs within the broader psychotherapy research literature and emphasizing the commonalities rather than differences between MBIs and other treatments might help guide future MBI research. To that end, I summarize the evidence for MBI efficacy and several MBI-specific psychological mechanisms, contextualize MBI findings within the broader psychotherapy literature from a common factors perspective, and propose suggestions for future research based on innovations and challenges occurring within psychotherapy research.
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Affiliation(s)
- Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin, Madison, WI, USA
- Center for Healthy Minds, University of Wisconsin, Madison, WI, USA
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Keefe JR, Hernandez S, Johanek C, Landy MSH, Sijercic I, Shnaider P, Wagner AC, Lane JEM, Monson CM, Stirman SW. Competence in Delivering Cognitive Processing Therapy and the Therapeutic Alliance Both Predict PTSD Symptom Outcomes. Behav Ther 2022; 53:763-775. [PMID: 35987537 DOI: 10.1016/j.beth.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/04/2021] [Accepted: 12/07/2021] [Indexed: 11/02/2022]
Abstract
Cognitive Processing Therapy (CPT) is efficacious in treating PTSD, but there remains a need to improve outcomes for individuals who do not fully respond to treatment. Differences between patient-therapist dyads in the fidelity (i.e., adherence and competence) of CPT delivery and the quality of the therapeutic relationship may partly explain differential levels of symptom improvement. Sessions were sampled from a randomized trial comparing different consultation conditions in training therapists new to CPT. Among 69 patients, one session from Sessions 1-3 and one session from Sessions 4-7 were reliably rated for adherence and competence using the CPT Therapist Adherence and Competence Scale, and for therapeutic alliance using the Working Alliance Inventory-Observer scale. Mixed models, including detrending using a fixed effect of session, predicted self-reported Posttraumatic Stress Disorder Checklist (PCL-IV) scores in one session using process scores from the previous session. The statistical interaction between fidelity and alliance scores to predict outcome was also examined. Alliance had significant, positive correlations (rs = 0.18-0.21) with same-session adherence and competence. Higher competence scores and higher therapeutic alliance scores in one session were independently associated with lower PCL-IV scores in the subsequent session. Adherence scores, which tended to be very high with relatively less variability, did not significantly relate to subsequent-session PCL-IV scores. Competence significantly interacted with alliance, such that sessions high in both competence and alliance predicted especially lower subsequent-session PCL-IV scores. A strong therapeutic alliance may have a synergistic, salutary effect with the competent delivery of CPT.
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Affiliation(s)
| | | | | | | | | | | | | | - Jeanine E M Lane
- Ryerson University, Toronto; Ontario Shores Center for Mental Health Sciences, Whitby, Ontario
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Brattland H, Holgersen KH, Vogel PA, Anderson T, Ryum T. An apprenticeship model in the training of psychotherapy students. Study protocol for a randomized controlled trial and qualitative investigation. PLoS One 2022; 17:e0272164. [PMID: 35998132 PMCID: PMC9397867 DOI: 10.1371/journal.pone.0272164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/13/2022] [Indexed: 12/01/2022] Open
Abstract
Background One approach towards advancing the quality of mental health care is to improve psychotherapists’ skills through education and training. Recently, psychotherapy training has benefitted from adapting training methods from other professions (e.g., deliberate practice). The apprenticeship model has a long history in skill trades and medicine, but has yet to be adopted in training mental health professionals. This study aims to investigate the impact of apprenticeship training on clinical psychology students’ skills. Methods In a pragmatic mixed-methods trial, 120 first year students in a Master’s degree clinical psychology program will be randomized to either training-as-usual or training-as-usual plus psychotherapy apprenticeship. In the intervention group, students will participate, over a period of 10 weeks, in weekly treatment sessions together with licensed therapists at outpatient mental health and substance use treatment clinics. Outcomes are assessed post-intervention and at two-year follow-up. The main outcome measure is the Facilitative Interpersonal Skills (FIS) performance test. Additional self-report measures tap self-efficacy, self-compassion, worry, rumination, and stress. Weekly reflection log entries written by the students will be qualitatively analyzed in order to gain an in-depth understanding of the learning process. Students’ and therapists’ experiences with the intervention will be explored in focus group interviews. Discussion To the best of our knowledge, this is the first controlled study to investigate the impact of apprenticeship as an isolated training component in the education of clinical psychologists. The study is designed so as to yield a comprehensive understanding of an approach which could prove to be a valuable supplement to the existing educational methods in this field and ultimately, contribute to improve the quality of mental health care.
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Affiliation(s)
- Heidi Brattland
- Nidelv Community Mental Health Center, St. Olav’s University Hospital, Trondheim, Norway
- * E-mail:
| | - Katrine Høyer Holgersen
- Nidelv Community Mental Health Center, St. Olav’s University Hospital, Trondheim, Norway
- Department of Psychology, the Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Patrick A. Vogel
- Department of Psychology, the Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Timothy Anderson
- Department of Psychology, Ohio University, Athens, Ohio, United States of America
| | - Truls Ryum
- Department of Psychology, the Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Zech JM, Steele R, Foley VK, Hull TD. Automatic rating of therapist facilitative interpersonal skills in text: A natural language processing application. Front Digit Health 2022; 4:917918. [PMID: 36052318 PMCID: PMC9425293 DOI: 10.3389/fdgth.2022.917918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundWhile message-based therapy has been shown to be effective in treating a range of mood disorders, it is critical to ensure that providers are meeting a consistently high standard of care over this medium. One recently developed measure of messaging quality–The Facilitative Interpersonal Skills Task for Text (FIS-T)–provides estimates of therapists’ demonstrated ability to convey psychotherapy's common factors (e.g., hopefulness, warmth, persuasiveness) over text. However, the FIS-T's scoring procedure relies on trained human coders to manually code responses, thereby rendering the FIS-T an unscalable quality control tool for large messaging therapy platforms.ObjectiveIn the present study, researchers developed two algorithms to automatically score therapist performance on the FIS-T task.MethodsThe FIS-T was administered to 978 messaging therapists, whose responses were then manually scored by a trained team of raters. Two machine learning algorithms were then trained on task-taker messages and coder scores: a support vector regressor (SVR) and a transformer-based neural network (DistilBERT).ResultsThe DistilBERT model had superior performance on the prediction task while providing a distribution of ratings that was more closely aligned with those of human raters, versus SVR. Specifically, the DistilBERT model was able to explain 58.8% of the variance (R2 = 0.588) in human-derived ratings and realized a prediction mean absolute error of 0.134 on a 1–5 scale.ConclusionsAlgorithms can be effectively used to ensure that digital providers meet a consistently high standard of interactions in the course of messaging therapy. Natural language processing can be applied to develop new quality assurance systems in message-based digital psychotherapy.
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Affiliation(s)
- James M. Zech
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
- Department of Research & Development, Talkspace, New York, NY, United States
- Correspondence: James M. Zech
| | - Robert Steele
- Department of Research & Development, Talkspace, New York, NY, United States
- Department of Computer Science, The University of Southern California, Los Angeles, CA, United States
| | - Victoria K. Foley
- Department of Psychology, The New School for Social Research, New York, NY, United States
| | - Thomas D. Hull
- Department of Research & Development, Talkspace, New York, NY, United States
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Affiliation(s)
- Iñigo R Arandia
- Department of Philosophy, IAS-Research Center for Life, Mind and Society, University of the Basque Country, Donostia, Spain
- ISAAC Lab, Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - Ezequiel A Di Paolo
- Department of Philosophy, IAS-Research Center for Life, Mind and Society, University of the Basque Country, Donostia, Spain
- Ikerbasque, Basque Foundation for Science, Bizkaia, Spain
- Centre for Computational Neuroscience and Robotics, University of Sussex, Brighton, United Kingdom
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Malins S, Figueredo G, Jilani T, Long Y, Andrews J, Rawsthorne M, Manolescu C, Clos J, Higton F, Waldram D, Hunt D, Perez Vallejos E, Moghaddam N. Developing An Automated Assessment of In-Session Patient Activation for Psychological Therapy: A Co-Development Approach (Preprint). JMIR Med Inform 2022; 10:e38168. [DOI: 10.2196/38168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
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Lewis AJ, Locke V, Heritage B, Seddon S. Trainee therapist personality and the rating of cognitive behavioural and dynamic interpersonal therapy processes. Clin Psychol Psychother 2022; 29:1679-1691. [PMID: 35199425 DOI: 10.1002/cpp.2730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/10/2022]
Abstract
Therapist factors are generally thought to be important predictors of the capacity to understand and respond to clinical material. The current study aims to identify which features of personality and clinical symptomatology predict a trainee therapist's rating of cognitive behavioural (CB) and psychodynamic interpersonal (PI) processes in video recordings of these therapies. Eighty psychology trainees completed the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and watched two video recordings of therapy sessions showing prototypical examples of CB and PI psychotherapy, rating the processes they could identify using the Comparative Psychotherapy Process Scale (CPPS). Trainees accurately differentiated CB from PI process while viewing the CB session but rated the CB video higher in PI processes than the PI video itself. Bayesian regression models showed that the most consistent MMPI-2-RF scale that predicted variance in ratings was hypomanic activation (RC9) predicting higher ratings of all psychotherapy processes in both conditions, while clinical scale factors such as Aggressiveness-Revised (AGGR-r) and personality scale factors of Psychoticism-Revised (PSYC-r) and Negative Emotionality/Neuroticism-Revised (NEGE-r) showed some notable but less consistent predictions. The variances in psychotherapy process ratings accounted for by MMPI-2-RF scales ranged from 15% to 51%. The study suggests that some clinical symptoms and personality factors do influence the rating of psychotherapy processes by psychology trainees, but further studies would be required to substantiate such findings. These findings have relevance to therapist training and selection for clinical training and therapist mental health.
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Affiliation(s)
- Andrew J Lewis
- Perinatal Mental Health Research Unit, Harry Perkins Medical Research Institute, Perth, Western Australia, Australia
| | - Vance Locke
- Western Kids Health, Subiaco, Western Australia, Australia
| | - Brody Heritage
- Child Health, Development and Education Team, Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Sarah Seddon
- School of Psychology, Murdoch University, South Street Campus, Perth, Western Australia, Australia
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Herzog P, Osen B, Stierle C, Middendorf T, Voderholzer U, Koch S, Feldmann M, Rief W, Brakemeier EL. Determining prognostic variables of treatment outcome in obsessive-compulsive disorder: effectiveness and its predictors in routine clinical care. Eur Arch Psychiatry Clin Neurosci 2022; 272:313-326. [PMID: 34218306 PMCID: PMC8866294 DOI: 10.1007/s00406-021-01284-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/14/2021] [Indexed: 01/07/2023]
Abstract
The objectives of this study were to investigate the naturalistic effectiveness of routine inpatient treatment for patients with obsessive-compulsive disorder (OCD) and to identify predictors of treatment outcome. A routinely collected data set of 1,596 OCD inpatients (M = 33.9 years, SD = 11.7; 60.4% female) having received evidence-based psychotherapy based on the cognitive-behavioral therapy (CBT) in five German psychotherapeutic clinics was analyzed. Effect sizes (Hedges' g) were calculated for several outcome variables to determine effectiveness. Predictor analyses were performed on a subsample (N = 514; M = 34.3 years, SD = 12.2; 60.3% female). For this purpose, the number of potential predictors was reduced using factor analysis, followed by multiple regression analysis to identify robust predictors. Effect sizes of various outcome variables could be classified as large (g = 1.34 of OCD-symptom change). Predictors of changes in OCD and depressive symptoms were symptom severity at admission and general psychopathological distress. In addition, patients with higher social support and more washing compulsions benefited more from treatment. Subgroup analyses showed a distinct predictor profile of changes in compulsions and obsessions. The results indicate that an evidence-based psychotherapy program for OCD can be effectively implemented in routine inpatient care. In addition to well-established predictors, social support, and washing compulsions in particular were identified as important positive predictors. Specific predictor profiles for changes in obsessions and compulsions are discussed.
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Affiliation(s)
- Philipp Herzog
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Bernhard Osen
- Schön-Klinik Bad Bramstedt, Psychosomatic Clinic, Birkenweg 10, 24576 Bad Bramstedt, Germany
| | - Christian Stierle
- Schön-Klinik Bad Bramstedt, Psychosomatic Clinic, Birkenweg 10, 24576 Bad Bramstedt, Germany
| | - Thomas Middendorf
- Schön-Klinik Bad Arolsen, Psychosomatic Clinic, Hofgarten 10, 34454 Bad Arolsen, Germany
| | - Ulrich Voderholzer
- Schön-Klinik Roseneck, Psychosomatic Clinic, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
| | - Stefan Koch
- Schön-Klinik Roseneck, Psychosomatic Clinic, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
| | - Matthias Feldmann
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
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Palma EMS, Gondim SMG. Psychotherapists’ psychological well‐being: The role of epistemic orientation and emotion regulation. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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48
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Dandachi-FitzGerald B, Meijs L, Moonen IMAJ, Merckelbach H. No self-serving bias in therapists' evaluations of clients' premature treatment termination: An approximate replication of Murdock et al. (2010). Clin Psychol Psychother 2021; 29:972-981. [PMID: 34694674 PMCID: PMC9298110 DOI: 10.1002/cpp.2677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/17/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022]
Abstract
In an often‐cited study, Murdock et al. (2010) found that therapists are more likely to attribute premature treatment termination to client characteristics than to themselves, a finding that the authors interpreted in terms of a self‐serving bias (SSB). We replicated and extended the study of Murdock et al. (2010, study 2). Psychologists and psychotherapists (N = 91) read two case vignettes about premature treatment terminations of clients that, in a between‐subjects set‐up, were either described as own clients or other therapists' clients. Next, participants used three attribution subscales (blaming therapist, client and situation) to evaluate potential causes for the premature terminations. This way, we tested whether participants would manifest SSB. We also investigated whether therapists' scores on self‐confidence and need for closure were linked to SSB tendencies. Unlike Murdock et al. (2010), we found no overall SSB. However, a stronger need for closure was related to more SSB tendencies (i.e., less endorsement of ‘blame therapist’ attributions) in the own‐client condition (r = −.35, p < .05, r2 = .12), but not in the other‐therapist's‐client condition (r = .17, p = .27). Our results suggest that SSB is not a ubiquitous phenomenon when therapists evaluate premature termination problems and that their willingness to attend to their own role depends to some extent on their need for closure.
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Affiliation(s)
| | - Laura Meijs
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Isabelle M A J Moonen
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Harald Merckelbach
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
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Malins S, Moghaddam N, Morriss R, Schröder T, Brown P, Boycott N. The predictive value of patient, therapist, and in-session ratings of motivational factors early in remote cognitive behavioural therapy for severe health anxiety. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:364-384. [PMID: 34514604 DOI: 10.1111/bjc.12328] [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: 06/16/2021] [Revised: 08/24/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Remote psychotherapy and the prevalence of Severe Health Anxiety (SHA) are both growing as a result of the COVID-19 pandemic. Remotely delivered Cognitive Behavioural Therapy (rCBT) for SHA is evidenced as effective, but many who seek help do not benefit. Motivational processes can influence outcomes, but it is unclear what assessment methods offer the best clinical utility in rCBT for SHA. DESIGN This study compared the predictive validity of patient, therapist and in-session ratings of motivational factors taken at session two of rCBT for SHA among high healthcare users experiencing multimorbidity. METHODS Motivational factors were assessed for 56 participants who attended at least two sessions of CBT for SHA delivered via video-conferencing or telephone. Following session two, therapists and patients completed online assessments of patient motivation. Two trained observers also rated motivational factors and therapeutic alliance from in-session interactions using session two recordings and transcripts. Multilevel modelling was used to predict health anxiety and a range of secondary health outcomes from motivation assessments. RESULTS Where patients were more actively engaged in discussion of positive changes during session two, greater outcome improvements ensued in health anxiety and all secondary outcomes. Conversely, larger proportions of session two spent describing problems predicted poorer outcomes. Therapist and patient assessments of motivation did not predict health anxiety, but therapist assessments of client confidence and motivation predicted all secondary outcomes. CONCLUSIONS Motivation remains an important process in CBT when delivered remotely, and motivational factors may predict outcomes more consistently from in-session interactions, compared to self-reports.
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Affiliation(s)
- Sam Malins
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK.,Nottinghamshire Healthcare NHS Foundation Trust, UK
| | | | - Richard Morriss
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK.,Nottinghamshire Healthcare NHS Foundation Trust, UK
| | - Thomas Schröder
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
| | - Paula Brown
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
| | - Naomi Boycott
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
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Thanbichler E, Evers O, Möller H, Taubner S. Entwicklung von Affiliation während der Psychotherapieausbildung. PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00528-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zusammenfassung
Fragestellung
Die Studie untersuchte die Entwicklung von Affiliation bei psychotherapeutischen Ausbildungskandidat:innen in Bezug auf ihr therapeutisches Handeln, ihre Selbstwahrnehmung und ihre Wahrnehmung von Klient:innen. Zudem wurde der Einfluss von Bindungsrepräsentationen und Selbsterfahrung auf die Affiliation betrachtet.
Material und Methode
In einem naturalistischen Prä-Post-Design bewerteten Ausbildungskandidat:innen unterschiedlicher therapeutischer Orientierungen (n = 126) verschiedene Affiliationsdimensionen in schwierigen Therapiesituationen (Intrex Questionnaire Short Form) über den Abstand von 3 Jahren. Bindungsangst und Bindungsvermeidung wurden zu Beginn (Experiences in Close Relationships, ECR-RD), Länge und Zufriedenheit der Selbsterfahrung am Ende des Erhebungszeitraums erfasst. Die Zusammenhangsanalysen wurden in Mehrebenenmodellen realisiert.
Ergebnisse
Die Affiliation im eigenen therapeutischen Verhalten und in der Wahrnehmung des Klient:innenverhaltens zeigte Steigerungen kleiner Effektgröße, wobei Bindungsvermeidung eine geringere Affiliation im eigenen Verhalten voraussagte. Die selbstbezogene Affiliation nahm mit einer mittleren Effektgröße ab; hierbei war Bindungsangst mit einer niedrigeren Affiliation assoziiert. Die Selbsterfahrungsdauer wies einen negativen Zusammenhang mit der Wahrnehmung des Klient:innenverhaltens auf; dieser Effekt kehrte sich bei hoher Bindungsvermeidung um. Die Zufriedenheit mit Selbsterfahrung hatte keinen Einfluss auf die Affiliationsentwicklung.
Schlussfolgerung
Die interpersonelle und intrapsychische Affiliation von angehenden Psychotherapeut:innen ist z. T. durch Bindungsrepräsentationen geprägt, unterliegt aber Entwicklungsprozessen. Die Abnahme selbstbezogener Affiliation zeigt die Notwendigkeit für kompensatorische und ressourcenstärkende Maßnahmen in der Psychotherapieausbildung.
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