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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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Scholten S, Schemer L, Herzog P, Haas JW, Heider J, Winter D, Reis D, Glombiewski JA. Leveraging Single-Case Experimental Designs to Promote Personalized Psychological Treatment: Step-by-Step Implementation Protocol with Stakeholder Involvement of an Outpatient Clinic for Personalized Psychotherapy. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01363-5. [PMID: 38467950 DOI: 10.1007/s10488-024-01363-5] [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: 02/27/2024] [Indexed: 03/13/2024]
Abstract
Our objective is to implement a single-case experimental design (SCED) infrastructure in combination with experience-sampling methods (ESM) into the standard diagnostic procedure of a German outpatient research and training clinic. Building on the idea of routine outcome monitoring, the SCED infrastructure introduces intensive longitudinal data collection, individual effectiveness measures, and the opportunity for systematic manipulation to push personalization efforts further. It aims to empower psychotherapists and patients to evaluate their own treatment (idiographic perspective) and to enable researchers to analyze open questions of personalized psychotherapy (nomothetic perspective). Organized around the principles of agile research, we plan to develop, implement, and evaluate the SCED infrastructure in six successive studies with continuous stakeholder involvement: In the project development phase, the business model for the SCED infrastructure is developed that describes its vision in consideration of the context (Study 1). Also, the infrastructure's prototype is specified, encompassing the SCED procedure, ESM protocol, and ESM survey (Study 2 and 3). During the optimization phase, feasibility and acceptability are tested and the infrastructure is adapted accordingly (Study 4). The evaluation phase includes a pilot implementation study to assess implementation outcomes (Study 5), followed by actual implementation using a within-institution A-B design (Study 6). The sustainability phase involves continuous monitoring and improvement. We discuss to what extent the generated data could be used to address current questions of personalized psychotherapy research. Anticipated barriers and limitations during the implementation processes are outlined.
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Affiliation(s)
- Saskia Scholten
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany.
| | - Lea Schemer
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Philipp Herzog
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
| | - Julia W Haas
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Jens Heider
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Dorina Winter
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Dorota Reis
- Applied Statistical Modeling, Universität des Saarlandes, Campus, 66123, Saarbrücken, Germany
| | - Julia Anna Glombiewski
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
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de Wit K, Begeman M, Noordkamp W, Sligte IG, Ghafoerkhan RS, Kallen VL. The effect of individual characteristics on susceptibility to aggressive and/or intimidating approaches: quantifying probability pathways by creating a victimization model. Eur J Psychotraumatol 2023; 14:2263147. [PMID: 38088188 PMCID: PMC10990447 DOI: 10.1080/20008066.2023.2263147] [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: 12/06/2022] [Accepted: 07/22/2023] [Indexed: 12/18/2023] Open
Abstract
Background: A significant body of literature has identified multiple factors that contribute to established victimization by aggressive and/or intimidating behaviours. These studies primarily originate from the fields of intimate partner violence (IPV), bullying, sexual abuse, and/or commercial sexual exploitation (CSE), and generally focus on female victims. It appears, however, complicated to quantify the cumulative contribution of these factors on susceptibility to intimidating and/or hostile engagements on an individual level.Objective: To develop a comprehensive risk model to quantify, on an individual level, the cumulative effects of previously reported characteristics on susceptibility to aggressive/intimidating approaches, leading to victimization (e.g. in the context of IPV/sexual abuse).Methods: A Bayesian belief network was developed using data from previous studies, capturing the multivariate contribution of previously reported characteristics on the likelihood of becoming victimized by aggressive and/or intimidating approaches (e.g. in the IPV/CSE context) in female victims aged 12-24 years.Results: The model showed that specific combinations of characteristics may contribute to an increased likelihood of victimization (e.g. in the context of IPV/bullying/sexual abuse or CSE). This likelihood could be quantified and categorized into specific clusters of factors differentiating between victimization by physically violent, non-physical, and/or sexual aggressive/intimidating approaches.Conclusion: The present model appears to be the first to successfully quantify the cumulative contribution of individual characteristics on the likelihood of becoming victimized by aggressive and/or intimidating approaches, typically leading to victimization. Moreover, the present scientific effort and resulting model suggest that there may be a latent variable mediating between the implemented factors and overall outcome, i.e. the susceptibility to aggressive and/or intimidating approaches. From that perspective, the model may also be considered as an initial outline to effectively indicate susceptibility to such approaches.
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Affiliation(s)
- Kay de Wit
- Department of Human Behaviour and Training, the Netherlands Organization for Applied Sciences (TNO), Soesterberg, the Netherlands
- Faculty of Social & Behavioural Sciences, Department of Brain & Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Melissa Begeman
- Department of Human Behaviour and Training, the Netherlands Organization for Applied Sciences (TNO), Soesterberg, the Netherlands
| | - Wouter Noordkamp
- Department of Military Operations, The Netherlands Organization for Applied Sciences (TNO), The Hague, the Netherlands
| | - Ilja G. Sligte
- Faculty of Social & Behavioural Sciences, Department of Brain & Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Rina S. Ghafoerkhan
- ARQ Centrum'45, ARQ National Psychotrauma Centre, Diemen, Diemen, the Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Victor L. Kallen
- Department of Human Behaviour and Training, the Netherlands Organization for Applied Sciences (TNO), Soesterberg, the Netherlands
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Wuttke-Linnemann A, Palm S, Geschke K, Skoluda N, Bischoff T, Nater UM, Endres K, Fellgiebel A. Psychobiological Evaluation of Day Clinic Treatment for People Living With Dementia – Feasibility and Pilot Analyses. Front Aging Neurosci 2022; 14:866437. [PMID: 35847670 PMCID: PMC9279127 DOI: 10.3389/fnagi.2022.866437] [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: 01/31/2022] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background Hospitalization is often stressful and burdensome for people living with dementia (PwD) and their informal caregivers (ICs). Day clinic treatment may provide a suitable alternative, but is often precluded by a diagnosis of dementia. Furthermore, it is often caregiver-based ratings that measure treatment success as the validity of self-reports in PwD is critically discussed. We therefore set out to examine the feasibility of psychobiological stress measures in PwD and ICs and to evaluate treatment trajectories considering both the day clinic context and the daily life of the dyads. Method A total of 40 dyads of PwD (mean age: 78.15 ± 6.80) and their ICs (mean age: 63.85 ± 13.09) completed paper-and-pencil questionnaires (covering stress, depressive symptoms, and caregiver burden among others) in addition to the measurement of hair cortisol concentrations (HCC) at admission, discharge, and follow-up 6 months after day clinic treatment. As part of an ambulatory assessment, for 2 days at the beginning and 2 days at the end of the day clinic treatment, PwD and ICs collected six saliva samples per day for the analysis of salivary cortisol (sCort) and alpha-amylase (sAA). Results Paper-and-pencil questionnaires and HCC assessments were more feasible than the ambulatory assessment. We found discrepancies between subjective and physiological markers of stress in PwD. Whereas HCC decreased over time, self-reported stress increased. Child–parent dyads reported decreases in neuropsychiatric symptoms, associated burden, and self-reported stress from admission to follow-up. In daily life, both PwD and ICs showed characteristic diurnal profiles of sAA and sCort, however, we found no differences in summary indicators of salivary stress markers over time. Discussion The psychobiological evaluation was feasible and added informative value, underlining the potential of physiological stress markers to complement self-reports on stress in PwD and to objectively evaluate treatment trajectories. In this sample, HCC was more feasible and acceptable as biological marker of stress compared to saliva samples. Concerning treatment trajectories, differential effects on the dyads were found, with child–parent dyads benefiting more from day clinic treatment compared to spousal dyads.
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Affiliation(s)
- Alexandra Wuttke-Linnemann
- Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
- *Correspondence: Alexandra Wuttke-Linnemann,
| | - Svenja Palm
- Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
| | - Katharina Geschke
- Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- Katharina Geschke,
| | - Nadine Skoluda
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
- University Research Platform “The Stress of Life (SOLE) – Processes and Mechanisms Underlying Everyday Life Stress”, University of Vienna, Vienna, Austria
| | - Theresa Bischoff
- Department of Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Urs M. Nater
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
- University Research Platform “The Stress of Life (SOLE) – Processes and Mechanisms Underlying Everyday Life Stress”, University of Vienna, Vienna, Austria
| | - Kristina Endres
- Department of Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andreas Fellgiebel
- Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- Hospital for Psychiatry, Psychosomatic and Psychotherapy, Agaplesion Elisabethenstift, Darmstadt, Germany
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Wongpakaran N, Wongpakaran T, Kövi Z. Development and validation of 21-item Outcome Inventory (OI-21). Heliyon 2022; 8:e09682. [PMID: 35711988 PMCID: PMC9193908 DOI: 10.1016/j.heliyon.2022.e09682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/04/2022] [Accepted: 06/01/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 50200, Thailand
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 50200, Thailand
- Corresponding author.
| | - Zsuzsanna Kövi
- Institute of Psychology, Centre of Specialist Postgraduate Programmes in Psychology, Károli Gáspár University of the Reformed Church in Hungary, Budapest, Hungary
- Corresponding author.
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Herzog P, Kaiser T, Brakemeier EL. Praxisorientierte Forschung in der Psychotherapie. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2022. [DOI: 10.1026/1616-3443/a000665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. In den letzten Jahrzehnten hat sich durch randomisiert-kontrollierte Studien (RCTs) eine breite Evidenzbasis von Psychotherapie mit mittleren bis großen Effekten für verschiedene psychische Störungen gebildet. Neben der Bestimmung dieser Wirksamkeit („Efficacy“) ebneten Studien zur Wirksamkeit unter alltäglichen Routinebedingungen („Effectiveness“) historisch den Weg zur Entwicklung eines praxisorientierten Forschungsparadigmas. Im Beitrag wird argumentiert, dass im Rahmen dieses Paradigmas praxisbasierte Studien eine wertvolle Ergänzung zu RCTs darstellen, da sie existierende Probleme in der Psychotherapieforschung adressieren können. In der gegenwärtigen praxisorientierten Forschung liefern dabei neue Ansätze aus der personalisierten Medizin und Methoden aus der ‚Computational Psychiatry‘ wichtige Anhaltspunkte zur Optimierung von Effekten in der Psychotherapie. Im Kontext der Personalisierung werden bspw. klinische multivariable Prädiktionsmodelle entwickelt, welche durch Rückmeldeschleifen an Praktiker_innen kurzfristig ein evidenzbasiertes Outcome-Monitoring ermöglicht und langfristig das Praxis-Forschungsnetzwerk in Deutschland stärkt. Am Ende des Beitrags werden zukünftige Richtungen für die praxisorientierte Forschung im Sinne des ‘Precision Mental Health Care’ -Paradigmas abgeleitet und diskutiert.
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Affiliation(s)
- Philipp Herzog
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Universität Koblenz-Landau, Deutschland
- Klinische Psychologie und Psychotherapie, Institut für Psychologie, Mathematisch-Naturwissenschaftliche Fakultät, Universität Greifswald, Deutschland
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Deutschland
| | - Tim Kaiser
- Klinische Psychologie und Psychotherapie, Institut für Psychologie, Mathematisch-Naturwissenschaftliche Fakultät, Universität Greifswald, Deutschland
| | - Eva-Lotta Brakemeier
- Klinische Psychologie und Psychotherapie, Institut für Psychologie, Mathematisch-Naturwissenschaftliche Fakultät, Universität Greifswald, Deutschland
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Deutschland
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