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Sarfan LD, Zieve G, Gumport NB, Xiong M, Harvey AG. Optimizing outcomes, mechanisms, and recall of Cognitive Therapy for depression: Dose of constructive memory support strategies. Behav Res Ther 2023; 166:104325. [PMID: 37210887 PMCID: PMC10513748 DOI: 10.1016/j.brat.2023.104325] [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: 12/17/2021] [Revised: 03/14/2023] [Accepted: 04/28/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Poor memory for treatment is associated with worse patient outcomes. Therapist use of constructive memory support strategies, which help patients actively engage with treatment content, may improve patient memory for treatment. We sought to identify the dose of constructive memory support needed to optimize treatment outcomes, mechanisms, and patient recall. METHOD Adults with major depressive disorder (N = 178, mean age = 37.9, 63% female, 17% Hispanic or Latino/a) were randomized to Cognitive Therapy plus a Memory Support Intervention or Cognitive Therapy as usual. Because therapists from both groups used constructive memory support, treatment conditions were combined to maximize data. Depression and overall impairment were assessed before treatment, immediately post-treatment (POST), and six (6FU) and 12 months (12FU) after treatment. Patients completed measures of treatment mechanisms - utilization/competency in Cognitive Therapy skills - and treatment recall at POST, 6FU, and 12FU. Patient adherence to treatment was averaged across sessions. RESULTS Using Kaplan-Meier Survival Analyses, the optimal dose of constructive memory support was eight uses per session (sensitivity analysis range: 5-12 uses). Pre-treatment depression symptoms and patient perceptions of treatment may impact the optimal dose. CONCLUSION Eight uses of constructive memory support by therapists per session may optimize treatment outcomes, mechanisms, and recall over the long-term.
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Affiliation(s)
- Laurel D Sarfan
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Garret Zieve
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Nicole B Gumport
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Mo Xiong
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Allison G Harvey
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
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Aslam AM, Kennedy J, Seghol H, Khisty N, Nicols TA, Adie S. A randomized controlled trial of patient recall after detailed written consent versus standard verbal consent in adults with routine orthopaedic trauma. Bone Jt Open 2023; 4:104-109. [PMID: 37051851 PMCID: PMC9999121 DOI: 10.1302/2633-1462.42.bjo-2022-0148.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Patient decision aids have previously demonstrated an improvement in the quality of the informed consent process. This study assessed the effectiveness of detailed written patient information, compared to standard verbal consent, in improving postoperative recall in adult orthopaedic trauma patients. This randomized controlled feasibility trial was conducted at two teaching hospitals within the South Eastern Sydney Local Health District. Adult patients (age ≥ 18 years) pending orthopaedic trauma surgery between March 2021 and September 2021 were recruited and randomized to detailed or standard methods of informed consent using a random sequence concealed in sealed, opaque envelopes. The detailed group received procedure-specific written information in addition to the standard verbal consent. The primary outcome was total recall, using a seven-point interview-administered recall questionnaire at 72 hours postoperatively. Points were awarded if the participant correctly recalled details of potential complications (maximum three points), implants used (maximum three points), and postoperative instructions (maximum one point). Secondary outcomes included the anxiety subscale of the Hospital and Anxiety Depression Scale (HADS-A) and visual analogue scale (VAS) for pain collected at 24 hours preoperatively and 72 hours postoperatively. Additionally, the Patient Satisfaction Questionnaire Short Form (PSQ-18) measured satisfaction at 72 hours postoperatively. A total of 60 patients were randomized, 32 to the standard group and 28 to the detailed group. Patients in the detailed group had significantly higher total recall score compared to the standard group (mean difference 1.29 points (95% confidence interval (CI) 0.51 to 2.08); p = 0.002). There were no differences in HADS-A (mean difference 0.39 (95% CI -2.11 to 2.88); p = 0.757), VAS pain (mean difference 5.71 (95% CI -22.25 to 11.11); p = 0.499), or PSQ-18 (mean difference 0.499; 95% CI -1.6 to 3.42; p = 0.392). Detailed written tools are useful in improving postoperative recall in adult orthopaedic trauma patients.
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Affiliation(s)
- Amjad M Aslam
- St. George and Sutherland Centre for Clinical Orthopaedic Research (SCORe), Sydney, Australia
| | | | | | | | | | - Sam Adie
- St. George and Sutherland Centre for Clinical Orthopaedic Research (SCORe), Sydney, Australia
- School of Clinical Medicine, UNSW Medicine and Health, St. George and Sutherland Campuses, Sydney, Australia
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Sarfan LD, Zieve GG, Mujir F, Gumport NB, Xiong M, Harvey AG. Serial Mediators of Memory Support Strategies Used With Cognitive Therapy for Depression: Improving Outcomes Through Patient Adherence and Treatment Skills. Behav Ther 2023; 54:141-155. [PMID: 36608972 PMCID: PMC10927275 DOI: 10.1016/j.beth.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 01/11/2023]
Abstract
Patient memory for treatment is poor. Memory support strategies can be integrated within evidence-based psychological treatments to improve patient memory for treatment, and thereby enhance patient outcomes. The present study evaluated possible mechanisms of these memory support strategies. Specifically, we tested whether therapist use of memory support strategies indirectly predicts improved patient outcomes via serial improvements in (a) patient adherence throughout treatment and (b) patient utilization and competency of treatment skills. Adults with major depressive disorder (N = 178, mean age = 37.93, 63% female, 17% Hispanic or Latino) were randomized to Cognitive Therapy plus a Memory Support Intervention or Cognitive Therapy-as-usual. Because therapists from both treatment groups used memory support strategies, data from conditions were combined. Blind assessments of depression severity and overall impairment were conducted before treatment, immediately posttreatment (POST), at 6-month follow-up (6FU), and at 12-month follow-up (12FU). Patient adherence to treatment was rated by therapists and averaged across treatment sessions. Patients completed measures of treatment mechanisms-namely, utilization and competency in cognitive therapy skills-at POST, 6FU, and 12FU. Results of serial mediation models indicated that more therapist use of memory support predicted lower depression severity at POST, 6FU, and 12FU indirectly and sequentially through (a) increased patient adherence during treatment and (b) more utilization and competency of Cognitive Therapy skills at POST, 6FU, and 12FU. The same patterns were found for serial mediation models predicting lower overall impairment at POST, 6FU, and 12FU. Together, boosting memory for treatment may represent a promising means to enhance pantreatment mechanisms (i.e., adherence and treatment skills) as well as patient outcomes.
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Affiliation(s)
| | | | | | | | - Mo Xiong
- University of California, Berkeley
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Müller UWD, Gerdes ABM, Alpers GW. Time is a great healer: Peak-end memory bias in anxiety - Induced by threat of shock. Behav Res Ther 2022; 159:104206. [PMID: 36270235 DOI: 10.1016/j.brat.2022.104206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/22/2022] [Accepted: 10/05/2022] [Indexed: 12/14/2022]
Abstract
Recently, we demonstrated that the peak-end memory bias, which is well established in the context of pain, can also be observed in anxiety: Retrospective evaluations of a frightening experience are worse when peak anxiety is experienced at the end of an episode. Here, we set out to conceptually replicate and extend this finding with rigorous experimental control in a threat of shock paradigm. We induced two intensity levels of anxiety by presenting visual cues that indicated different strengths of electric stimuli. Each of the 59 participants went through one of two conditions that only differed in the order of moderate and high threat phases. As a manipulation check, orbicularis-EMG to auditory startle probes, electrodermal activity, and state anxiety confirmed the effects of the specific threat exposure. Critically, after some time had passed, participants for whom exposure had ended with high threat reported more anxiety for the entire episode than those for whom it ended with moderate threat. Moreover, they ranked their experience as more aversive when compared to other unpleasant everyday experiences. This study overcomes several previous limitations and speaks to the generalizability of the peak-end bias. Most notably, the findings bear implications for exposure therapy in clinical anxiety.
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Affiliation(s)
- Ulrich W D Müller
- School of Social Sciences, Department of Psychology, University of Mannheim, Germany
| | - Antje B M Gerdes
- School of Social Sciences, Department of Psychology, University of Mannheim, Germany
| | - Georg W Alpers
- School of Social Sciences, Department of Psychology, University of Mannheim, Germany.
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Prieto-Gómez V, Yuste-Sánchez MJ, Bailón-Cerezo J, Romay-Barrero H, de la Rosa-Díaz I, Lirio-Romero C, Torres-Lacomba M. Effectiveness of Therapeutic Exercise and Patient Education on Cancer-Related Fatigue in Breast Cancer Survivors: A Randomised, Single-Blind, Controlled Trial with a 6-Month Follow-Up. J Clin Med 2022; 11:269. [PMID: 35012011 PMCID: PMC8746078 DOI: 10.3390/jcm11010269] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 01/27/2023] Open
Abstract
This study aimed to determine the effectiveness of therapeutic exercise plus patient therapeutic education on perceived fatigue, functional capacity and pain in breast cancer survivors with cancer-related fatigue. A randomised, single-blind, clinical trial was conducted with a total of 80 breast cancer survivors who presented cancer-related fatigue. Women were randomised into a supervised therapeutic exercise group (STE-G) (n = 40) or an unsupervised exercise group (UE-G) (n = 40). Both interventions included patient therapeutic education and were delivered in three sessions per week over eight weeks. The main outcome was perceived fatigue as assessed by the Spanish version of the Functional Assessment of Chronic Illness Therapy-Fatigue subscale (FACIT-F). Other evaluated outcomes were pain measured on a visual analogue scale, and distance measured using the 6-Minute Walk Test. Data were collected at baseline, immediately post-intervention, and at three and six months after baseline. Significantly greater improvements across all variables were observed in the STE-G throughout the entire follow-up period with the exception of pain. Conclusions: A supervised therapeutic exercise program plus patient therapeutic education significantly reduce perceived fatigue and increase functional capacity in breast cancer survivors suffering from cancer-related fatigue compared to an unsupervised physical exercise program based on individual preferences with patient therapeutic education.
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Affiliation(s)
- Virginia Prieto-Gómez
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (V.P.-G.); (M.J.Y.-S.); (J.B.-C.); (I.d.l.R.-D.); (C.L.-R.)
- Department of Nursery, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursery, University of Castilla-La Mancha, 45071 Toledo, Spain;
| | - María José Yuste-Sánchez
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (V.P.-G.); (M.J.Y.-S.); (J.B.-C.); (I.d.l.R.-D.); (C.L.-R.)
| | - Javier Bailón-Cerezo
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (V.P.-G.); (M.J.Y.-S.); (J.B.-C.); (I.d.l.R.-D.); (C.L.-R.)
- Centro Superior de Estudios Universitarios La Salle, Department of Physical Therapy, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Helena Romay-Barrero
- Department of Nursery, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursery, University of Castilla-La Mancha, 45071 Toledo, Spain;
| | - Irene de la Rosa-Díaz
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (V.P.-G.); (M.J.Y.-S.); (J.B.-C.); (I.d.l.R.-D.); (C.L.-R.)
- Centro Superior de Estudios Universitarios La Salle, Department of Physical Therapy, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Cristina Lirio-Romero
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (V.P.-G.); (M.J.Y.-S.); (J.B.-C.); (I.d.l.R.-D.); (C.L.-R.)
- Department of Nursery, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursery, University of Castilla-La Mancha, 45071 Toledo, Spain;
| | - María Torres-Lacomba
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (V.P.-G.); (M.J.Y.-S.); (J.B.-C.); (I.d.l.R.-D.); (C.L.-R.)
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Siegrist V, Mata R, Langewitz W, Gerger H, Furger S, Hertwig R, Bingisser R. Does information structuring improve recall of discharge information? A cluster randomized clinical trial. PLoS One 2021; 16:e0257656. [PMID: 34662341 PMCID: PMC8523048 DOI: 10.1371/journal.pone.0257656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 07/29/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The impact of the quality of discharge communication between physicians and their patients is critical on patients' health outcomes. Nevertheless, low recall of information given to patients at discharge from emergency departments (EDs) is a well-documented problem. Therefore, we investigated the outcomes and related benefits of two different communication strategies: Physicians were instructed to either use empathy (E) or information structuring (S) skills hypothesizing superior recall by patients in the S group. METHODS For the direct comparison of two communication strategies at discharge, physicians were cluster-randomized to an E or a S skills training. Feasibility was measured by training completion rates. Outcomes were measured in patients immediately after discharge, after 7, and 30 days. Primary outcome was patients' immediate recall of discharge information. Secondary outcomes were feasibility of training implementation, patients' adherence to recommendations and satisfaction, as well as the patient-physician relationship. RESULTS Of 117 eligible physicians, 80 (68.4%) completed the training. Out of 256 patients randomized to one of the two training groups (E: 146 and S: 119) 196 completed the post-discharge assessment. Patients' immediate recall of discharge information was superior in patients in the S-group vs. E-group. Patients in the S-group adhered to more recommendations within 30 days (p = .002), and were more likely to recommend the physician to family and friends (p = .021). No differences were found on other assessed outcome domains. CONCLUSIONS AND PRACTICE IMPLICATIONS Immediate recall and subsequent adherence to recommendations were higher in the S group. Feasibility was shown by a 69.6% completion rate of trainings. Thus, trainings of discharge information structuring are feasible and improve patients' recall, and may therefore improve quality of care in the ED.
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Affiliation(s)
- Victoria Siegrist
- Emergency Department, University Hospital Basel, Basel, Switzerland
- Center for Cognitive and Decision Sciences, University of Basel, Basel, Switzerland
| | - Rui Mata
- Center for Cognitive and Decision Sciences, University of Basel, Basel, Switzerland
| | - Wolf Langewitz
- Department of Psychosomatic Medicine–Communication in Medicine, University Hospital Basel, Basel, Switzerland
| | - Heike Gerger
- Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Stephan Furger
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Ralph Hertwig
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
- * E-mail:
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Cenkner DP, Asnaani A, DiChiara C, Harb GC, Lynch KG, Greene J, Scott JC. Neurocognitive Predictors of Treatment Outcomes in Cognitive Processing Therapy for Post-traumatic Stress Disorder: Study Protocol. Front Psychol 2021; 12:625669. [PMID: 33574791 PMCID: PMC7870481 DOI: 10.3389/fpsyg.2021.625669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background Post-traumatic stress disorder (PTSD) is a prevalent, debilitating, and costly psychiatric disorder. Evidenced-based psychotherapies, including Cognitive Processing Therapy (CPT), are effective in treating PTSD, although a fair proportion of individuals show limited benefit from such treatments. CPT requires cognitive demands such as encoding, recalling, and implementing new information, resulting in behavioral change that may improve PTSD symptoms. Individuals with PTSD show worse cognitive functioning than those without PTSD, particularly in acquisition of verbal memory. Therefore, memory dysfunction may limit treatment gains in CPT in some individuals with PTSD. Methods and Analysis Here, we present a protocol describing the Cognition and PsychoTherapy in PTSD (CPTPTSD) study, a prospective, observational study examining how cognitive functioning affects treatment response in CPT for PTSD (NCT# 03641924). The study aims to recruit 105 outpatient veterans with PTSD between the ages of 18 and 70 years. Prior to beginning 12 sessions of CPT, Veteran participants will have standardized assessments of mood and functioning and complete a comprehensive neurocognitive battery assessing episodic learning, attention and speed of processing, language ability, executive control, and emotional functioning. This study aims to fill gaps in the current literature by: (1) examining the specificity of memory effects on treatment response; (2) exploring how baseline cognitive functioning impacts functional outcomes; and (3) examining potential mechanisms, such as memory for treatment content, that might explain the effects of baseline memory functioning on PTSD symptom trajectory. Discussion If successful, this research could identify clinically relevant neurocognitive mechanisms that may impact PTSD psychotherapy and guide the development of individualized treatments for PTSD.
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Affiliation(s)
- David P Cenkner
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Anu Asnaani
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Christina DiChiara
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Gerlinde C Harb
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Kevin G Lynch
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jennifer Greene
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - J Cobb Scott
- VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Zieve GG, Woodworth C, Harvey AG. Client memory and learning of treatment contents: An experimental study of intervention strategies and relationship to outcome in a brief treatment for procrastination. J Behav Ther Exp Psychiatry 2020; 69:101579. [PMID: 32459987 PMCID: PMC7442618 DOI: 10.1016/j.jbtep.2020.101579] [Citation(s) in RCA: 2] [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: 04/25/2019] [Revised: 03/13/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Client memory and learning is limited for psychological treatment contents. This study investigated different approaches to support client memory and learning of treatment contents and the relationship between memory and learning of treatment contents and outcome. METHODS Adult participants (n = 428) were recruited through Amazon's Mechanical Turk and randomized to complete one of three versions of a one-session procrastination intervention. Two versions of the intervention included different amounts of memory support strategy types from the Memory Support Intervention. A control version did not include any types of memory support. Memory and learning of treatment contents were assessed immediately after the intervention and one week later. Procrastination and two mechanisms of procrastination (impulsiveness and self-efficacy) were assessed at baseline and one week after the intervention. RESULTS Contrary to the hypotheses, a version of the intervention with multiple types of memory support strategies was not associated with better memory and learning of treatment contents than a version of the intervention with only one type of memory support strategy or the control intervention. Greater memory and learning of treatment contents predicted improvement in mechanisms of procrastination, but not procrastination itself. LIMITATIONS The mean level of procrastination in this study was lower than in other treatment studies of procrastination. CONCLUSIONS Results partially support the rationale for the Memory Support Intervention that improving client memory and learning of treatment contents can improve outcome. Findings suggest that the Memory Support Intervention may be simplified to include fewer strategies without compromising efficacy.
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Lee JY, Dong L, Gumport NB, Harvey AG. Establishing the dose of memory support to improve patient memory for treatment and treatment outcome. J Behav Ther Exp Psychiatry 2020; 68:101526. [PMID: 31733608 DOI: 10.1016/j.jbtep.2019.101526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/08/2019] [Accepted: 11/05/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient memory for the contents of treatment sessions is poor and this is associated with worse treatment outcome. Preliminary findings indicate that treatment provider use of memory support can be helpful in enhancing patient memory for treatment and improving outcome. The development of a novel Memory Support Intervention is currently underway. A key step in this process is to establish the dose of memory support that treatment providers deliver in treatment-as-usual, as well as the optimal dose of memory support needed to maximize patient memory for treatment points and outcomes. METHODS Forty-two adults with major depressive disorder (MDD) were randomized to receive either cognitive therapy plus memory support (CS + Memory Support; n = 22) or cognitive therapy as-usual (CT-as-usual; n = 20). Patients completed a free recall of treatment points task at post-treatment. Outcome measures were administered at baseline and post-treatment. RESULTS Treatment providers delivering CT-as-usual used, on average, 8.39 instances of memory support and 3.40 different types of memory support per session. Receiver Operating Characteristics (ROC) analyses using the combined sample indicate that 12.45 instances of memory support and 3.88 to 4.13 different types of memory support are needed to maximize patient recall and functional outcome. LIMITATIONS Dosing recommendations were established using a limited sample of participants receiving cognitive therapy for MDD. CONCLUSIONS Treatment providers appear to deliver a suboptimal amount of memory support. Delivering the optimal dose of memory support could improve treatment outcome.
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Affiliation(s)
- Jason Y Lee
- University of California, Berkeley, Department of Psychology, 2121 Berkeley Way #1650, Berkeley, CA, 94720-1650, USA.
| | - Lu Dong
- University of California, Berkeley, Department of Psychology, 2121 Berkeley Way #1650, Berkeley, CA, 94720-1650, USA.
| | - Nicole B Gumport
- University of California, Berkeley, Department of Psychology, 2121 Berkeley Way #1650, Berkeley, CA, 94720-1650, USA.
| | - Allison G Harvey
- University of California, Berkeley, Department of Psychology, 2121 Berkeley Way #1650, Berkeley, CA, 94720-1650, USA.
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Bruijniks SJE, Sijbrandij M, Huibers MJH. The effects of retrieval versus rehearsal of online problem-solving therapy sessions on recall, problem-solving skills and distress in distressed individuals: An experimental study. J Behav Ther Exp Psychiatry 2020; 66:101485. [PMID: 31491535 DOI: 10.1016/j.jbtep.2019.101485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/29/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Improving memory for the content of therapy sessions might increase the effects of psychological interventions. Previous studies showed that healthy individuals who took a memory test (retrieval) of studied material showed better long-term memory retention than individuals who restudied (rehearsal) the material. The aim of the current study was to find out whether we can translate these findings to a subclinical setting. METHODS Individuals with moderate levels of distress were randomized into retrieving (n = 46) or rehearsing (n = 49) four weekly sessions of online Problem-Solving Therapy (PST). Session recall, problem-solving skills and distress were measured at baseline, three days after each session and at one-week follow-up. RESULTS Retrieval led to overall higher recall, but this difference disappeared when controlling for the time spent on retrieval versus rehearsal. Retrieval did not lead to better problem-solving skills or less distress, compared to rehearsal. Baseline working memory performance moderated the effect of condition on recall after controlling for the time spent on retrieval versus rehearsal: the effect of retrieval compared to rehearsal on recall was larger for individuals with lower working memory performance. LIMITATIONS The sample mostly consisted of university students with overall high working memory scores. CONCLUSIONS This study provided the first evidence that retrieval of the content of PST sessions may lead to better session recall compared to rehearsal of the PST sessions in individuals with a low working memory score. Implications for the use of cognitive support strategies within a therapeutic setting are discussed.
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Affiliation(s)
- Sanne J E Bruijniks
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
| | - Marit Sijbrandij
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Marcus J H Huibers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands; Department of Psychology, University of Pennsylvania, Philadelphia, United States
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Zakeri MA, Khoshnood Z, Dehghan M, Abazari F. The effect of the Continuous Care Model on treatment adherence in patients with myocardial infarction: a randomised controlled trial. J Res Nurs 2020; 25:54-65. [PMID: 34394607 DOI: 10.1177/1744987119890666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Adherence to treatment is one of the behaviours associated with successful outcomes following a myocardial infarction, which leads to successful treatment in the disease. Aims This study aimed to investigate the effect of the Continuous Care Model (CCM) on treatment adherence in patients with myocardial infarction. Methods This was a randomised controlled trial performed on 82 patients with myocardial infarction. Convenience sampling was used to select the participants, and then they were allocated into two groups by the stratified random method. In the intervention group, a CCM was implemented. In the intervention group, 4-6 educational sessions (1-2 h) were conducted during one month in the form of spoken questions and answers about the presented subjects. The control group received routine care. A questionnaire of demographic information and treatment adherence was completed by samples in the two groups, intervention and control, before and immediately after training and after follow-up. Results The results of this study showed that treatment adherence was significantly higher in the intervention group than in the control group immediately after training and after the follow-up phase (three months) (p < 0.001). Also, diet, drug and physical activity adherence were significantly higher in the intervention group than in the control group immediately after training and after follow-up (p < 0.001). Conclusions Implementation of CCM led to an increase in adherence to the treatment in patients with myocardial infarction. Therefore, it is suggested that this model could be used as a nursing intervention to increase treatment adherence in cardiac-rehabilitation programmes.
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Affiliation(s)
- Mohammad Ali Zakeri
- MSc in Nursing, Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zohreh Khoshnood
- Assisstant Professor, Nursing Research Center, Razi Nursing and Midwifery Department, Kerman University of Medical Science, Kerman, Iran
| | - Mahlagha Dehghan
- Assistant Professor, Department of Critical care, School of Nursing and Midwifery, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Farokh Abazari
- Assistant Professor, Department of Community Health, School of Nursing and Midwifery, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Zieve GG, Dong L, Weaver C, Ong SL, Harvey AG. Patient constructive learning behavior in cognitive therapy: A pathway for improving patient memory for treatment? Behav Res Ther 2019; 116:80-89. [PMID: 30852323 DOI: 10.1016/j.brat.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/16/2018] [Accepted: 02/24/2019] [Indexed: 10/27/2022]
Abstract
Patient memory for treatment is poor and associated with worse outcome. The Memory Support Intervention was designed to improve outcome by enhancing patient memory for treatment. Half of the strategies comprising the Memory Support Intervention (termed constructive memory support strategies) involve therapists inviting patients to construct new ideas, inferences, or connections related to treatment material that go beyond information already presented by therapists. This study investigated the relationship between patient responses to therapist use of constructive memory support strategies and patient recall of treatment contents. Therapist uses of constructive memory support strategies were coded from sessions recorded during a pilot trial of the Memory Support Intervention in the context of cognitive therapy for depression (n = 44 patients). Patients who successfully constructed new ideas, inferences, or connections (termed patient constructive learning behavior) in response to therapist use of constructive memory support strategies showed greater recall of treatment contents. Mediation analyses provided some evidence that patient constructive learning behavior may be a mechanism through which the Memory Support Intervention results in enhanced patient memory. Results highlight patient constructive learning behavior as a potential pathway for improving patient memory for treatment.
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Affiliation(s)
- Garret G Zieve
- Department of Psychology, University of California, Berkeley, United States
| | - Lu Dong
- Department of Psychology, University of California, Berkeley, United States
| | - Claire Weaver
- Department of Psychology, University of California, Berkeley, United States
| | - Stacie L Ong
- Department of Psychology, University of California, Berkeley, United States
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, United States.
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Berg M, Rozental A, Johansson S, Liljethörn L, Radvogin E, Topooco N, Andersson G. The role of knowledge in internet-based cognitive behavioural therapy for adolescent depression: Results from a randomised controlled study. Internet Interv 2019; 15:10-17. [PMID: 30519531 PMCID: PMC6260280 DOI: 10.1016/j.invent.2018.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Clients' knowledge about their condition and treatment is considered crucial for general health improvement, and knowledge acquisition is an essential part in internet-based cognitive behavioural therapy (ICBT). Yet, little is known about the role of knowledge and how it influences treatment outcome. This study aimed to examine if explicit knowledge increased following ICBT for adolescent depression, if knowledge gain would be associated with symptom reduction, and if pre-existing knowledge predicted changes in depressive symptoms. METHODS Seventy-one adolescents were randomised to a therapist-supported ICBT or a attention control condition. A measure of depression (BDI-II) and a knowledge test dealing with depression, comorbid anxiety, and its CBT-treatment were administered before and after treatment. RESULTS Significant improvements in knowledge were observed following ICBT compared to the attention control (between-group Cohen's d = 1.25, 95% CI [0.67-1.79]). On average, participants in the treatment group answered 1.4 more questions correctly at post treatment compared to the control group. No relation between change in knowledge and change in depressive symptoms could be observed. Knowledge scores at baseline were high for both groups, with participants answering approximately 75% of the questions correct. A higher level of initial knowledge level predicted poorer treatment response (Parson's r = -0.38, p = .048). CONCLUSIONS The findings indicate that knowledge about basic concepts and principles about depression, anxiety, and CBT increases following ICBT. This increase in knowledge was not related to change in depressive symptoms, indicating that knowledge is a different construct. The results also suggest that clients who are more knowledgeable prior to treatment might benefit less from ICBT. In sum, the results highlight the need to further examine the role of knowledge in ICBT.
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Affiliation(s)
- Matilda Berg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Alexander Rozental
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Institute of Child Health, University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Sofie Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Lina Liljethörn
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Ella Radvogin
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Patient Memory for Psychological Treatment Contents: Assessment, Intervention, and Future Directions for a Novel Transdiagnostic Mechanism of Change. BEHAVIOUR CHANGE 2019. [DOI: 10.1017/bec.2019.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractPatient memory for treatment contents is defined as memory for the ideas, concepts, skills, and/or insights (termed treatment points) that the therapist thinks are important for the patient to remember and implement as a part of therapy. This article reviews key findings on patient memory for treatment contents, describes the development and evaluation of the Memory Support Intervention (MSI), and outlines future directions for research. Patient memory for treatment contents is poor, and worse memory is associated with worse treatment outcome. The MSI is composed of eight memory support strategies that therapists incorporate frequently alongside treatment points delivered during treatment-as-usual. Training therapists to deliver the MSI may yield better treatment outcomes by enhancing patient memory for treatment contents. Future research is needed to understand how to best measure patient memory for treatment contents, and the mediators, moderators, and dissemination potential of the MSI.
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Kredlow MA, Eichenbaum H, Otto MW. Memory creation and modification: Enhancing the treatment of psychological disorders. AMERICAN PSYCHOLOGIST 2018; 73:269-285. [PMID: 29494172 PMCID: PMC5897133 DOI: 10.1037/amp0000185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Modification of the ongoing influence of maladaptive cognitive, emotional, and behavioral patterns is a fundamental feature of many psychological treatments. Accordingly, a clear understanding of the nature of memory adaptation and accommodation to therapeutic learning becomes an important issue for (1) understanding the impact of clinical interventions, and (2) considering innovations in treatment strategies. In this article, we consider advances in the conceptualization of memory processes and memory modification research relative to clinical treatment. We review basic research on the formation of memories, the way in which new learning is integrated within memory structures, and strategies to influence the nature and degree to which new learning is integrated. We then discuss cognitive/behavioral and pharmacological strategies for influencing memory formation in relation to disorder prevention or treatment. Our goal is to foster awareness of current strategies for enhancing therapeutic learning and to encourage research on potential new avenues for memory enhancement in service of the treatment of mental health disorders. (PsycINFO Database Record
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Affiliation(s)
| | | | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University
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Dong L, Zhao X, Ong SL, Harvey AG. Patient recall of specific cognitive therapy contents predicts adherence and outcome in adults with major depressive disorder. Behav Res Ther 2017; 97:189-199. [PMID: 28822879 DOI: 10.1016/j.brat.2017.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/28/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
The current study examined whether and which specific contents of patients' memory for cognitive therapy (CT) were associated with treatment adherence and outcome. Data were drawn from a pilot RCT of forty-eight depressed adults, who received either CT plus Memory Support Intervention (CT + Memory Support) or CT-as-usual. Patients' memory for treatment was measured using the Patient Recall Task and responses were coded into cognitive behavioral therapy (CBT) codes, such as CBT Model and Cognitive Restructuring, and non-CBT codes, such as individual coping strategies and no code. Treatment adherence was measured using therapist and patient ratings during treatment. Depression outcomes included treatment response, remission, and recurrence. Total number of CBT codes recalled was not significantly different comparing CT + Memory Support to CT-as-usual. Total CBT codes recalled were positively associated with adherence, while non-CBT codes recalled were negatively associated with adherence. Treatment responders (vs. non-responders) exhibited a significant increase in their recall of Cognitive Restructuring from session 7 to posttreatment. Greater recall of Cognitive Restructuring was marginally significantly associated with remission. Greater total number of CBT codes recalled (particularly CBT Model) was associated with non-recurrence of depression. Results highlight the important relationships between patients' memory for treatment and treatment adherence and outcome.
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Affiliation(s)
- Lu Dong
- Department of Psychology, University of California, Berkeley, United States
| | - Xin Zhao
- Department of Psychology, University of California, Berkeley, United States
| | - Stacie L Ong
- Department of Psychology, University of California, Berkeley, United States
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, United States.
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Dolsen MR, Soehner AM, Morin CM, Bélanger L, Walker M, Harvey AG. Sleep the night before and after a treatment session: A critical ingredient for treatment adherence? J Consult Clin Psychol 2017; 85:647-652. [PMID: 28394172 PMCID: PMC5568544 DOI: 10.1037/ccp0000184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Sleep prepares key neural structures for next-day learning, and sleep obtained after learning promotes subsequent memory consolidation supporting long-term retention. This study examined whether sleep the night before and after a therapy session predicts aspects of treatment adherence. METHOD As part of a randomized clinical trial, 188 adults (62.7% female, mean age = 47.5, 80.5% Caucasian) with persistent insomnia received cognitive-behavioral therapy for insomnia. Patients completed a sleep diary before and after treatment sessions. Minutes spent awake during the night (total wake time; TWT) and total sleep time (TST) were used as measures of sleep disturbance. At each treatment session, therapists rated participant understanding of the session and homework compliance from the previous session. RESULTS Compared to longer TWT, before session shorter TWT was associated with increased treatment understanding the next day. After session shorter TWT was also associated with increased understanding, but not homework compliance the subsequent session compared to participants with longer TWT. Similar results were obtained for TST. CONCLUSIONS Improving sleep may benefit patient adherence to treatment. Sleep may influence processes related to initial learning and subsequent consolidation of treatment information. Future studies should examine whether improved sleep within other psychiatric disorders is also an ingredient to the successful outcome of psychosocial interventions. (PsycINFO Database Record
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Affiliation(s)
| | - Adriane M Soehner
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | | | - Matthew Walker
- Department of Psychology, University of California, Berkeley
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