Bridging the gap between clinical research and clinical practice: introduction to the special section

Improving emotion regulation ability after brain injury: A systematic review of targeted interventions

Emotion dysregulation is a common sequela after a brain injury, and it can have serious negative consequences for individuals, families, and the community. A systematic review of the literature was conducted to identify and evaluate interventions designed to improve emotion regulation ability in adults with acquired brain injury. Studies were identified on ProQuest, PsycInfo, ScienceDirect, Scopus, and Web of Science; last searched on 3 August 2023. A review protocol was prospectively registered on PROSPERO (CRD42020218175). Risk of bias was assessed using the Cochrane Risk-of-Bias tool (version 2). Sixteen studies were included in the review comprising one case series, five pilot studies, four pre-post studies, and six RCTs. There was a total of 652 participants across studies. Fourteen of the sixteen studies reported statistically significant improvements in at least one emotional functioning variable. Ten studies reported medium-large effect sizes. Limitations included inconsistency in the measurement, reporting of intervention outcomes and processes. Future directions are discussed.

Randomized Controlled Trial Evaluating the Effectiveness of a Direct-to-Consumer Marketing Video About Patients' Right to Evidence-Based Mental Health Care

ABSTRACT

This study evaluated the impact of a direct-to-consumer (DTC) marketing video designed to educate the public about patients' rights to evidence-based mental health care (EBMHC). Participants ( N = 632) were randomly assigned to an active DTC video condition, a control video condition, or a control condition without a video. Participants who watched the DTC video ( vs . both control conditions) had significantly greater knowledge of patients' rights to EBMHC. Further, individuals who watched the DTC ( vs . control) video reported significantly greater comfort with accessing care and perceived their assigned video as significantly more culturally sensitive. However, participants who watched the DTC video were not significantly different from both control conditions on self-report measures of self-efficacy in working with a provider, likelihood of asking a provider about one's rights, treatment-seeking intentions, and self-stigma. Findings suggest the potential for a DTC video to promote knowledge of EBMHC, though its impact on help-seeking perceptions and intentions was less promising.

Implementation Science and Practice-Oriented Research: Convergence and Complementarity

Implementation science is the scientific study of methods to promote the uptake of research findings and other evidence-based practices in routine care, with the goal of improving the quality and effectiveness of health services (Bauer et al., 2015). In addition to this common goal, practice-oriented psychotherapy research (and researchers) and implementation science (and scientists) share a common focus on the people and the places where treatment happens. Thus, there exists strong potential for combining these two approaches. In this article, we provide a primer on implementation science for psychotherapy researchers and highlight important areas and examples of convergence and complementarity between implementation science and practice-oriented psychotherapy research. Specifically, we (a) define and describe the core features of implementation science; (b) discuss similarities and areas of complementarity between implementation science and practice-oriented psychotherapy research; (c) discuss a case example that exemplifies the integration of implementation science and practice-oriented research; and (d) propose directions for future research and collaborations that leverage both implementation science and practice-oriented research.

Benchmarks for dialectical behavioural therapy intervention in adults and adolescents with borderline personality symptoms

Background

Dialectical Behaviour Therapy (DBT) is a multi-component cognitive behavioural intervention with proven efficacy in treating people with borderline personality disorder symptoms. Establishing benchmarks for DBT intervention with both adults and adolescents is essential for bridging the gap between research and clinical practice, improving teams' performance and procedures.

Aim

This study aimed to establish benchmarks for DBT using the EQ-5D, Borderline Symptoms List (BSL) and Difficulties in Emotion Regulation Scale (DERS) for adults and adolescents.

Methods

After searching four databases for randomised controlled trials and effectiveness studies that applied standard DBT to people with borderline symptoms, a total of 589 studies were included (after duplicates' removal), of which 16 met our inclusion criteria. A meta-analysis and respective effect-size pooling calculations (Hedges-g) were undertaken, and heterogeneity between studies was assessed with I2 and Q tests. Benchmarks were calculated using pre-post treatment means of the studies through aggregation of adjusted effect sizes and critical values.

Results

DBT aggregated effect sizes per subsample derived from RCTs and effectiveness studies are presented, along with critical values, categorised by age group (adults vs adolescents), mode of DBT treatment (full-programme vs skills-training) and per outcome measure (EQ-5D, BSL and DERS).

Conclusions

Practitioners from routine clinical practice delivering DBT and researchers can now use these benchmarks to evaluate their teams' performance according to their clients' outcomes, using the EQ-5D, BSL and DERS. Through benchmarking, teams can reflect on their teams' efficiency and determine if their delivery needs adjustment or if it is up to the standards of current empirical studies.

Association of Digital Engagement With Relaxation Tools and Stress Level Reduction: Retrospective Cohort Study

BACKGROUND

Stress is an emotional response caused by external triggers and is a high-prevalence global problem affecting mental and physical health. Several different digital therapeutic solutions are effective for stress management. However, there is limited understanding of the association between relaxation components and stress levels when using a digital app.

OBJECTIVE

This study investigated the contribution of relaxation tools to stress levels over time. We hypothesized that participation in breathing exercises and cognitive behavioral therapy-based video sessions would be associated with a reduction in stress levels. We also hypothesized a significant reduction specifically in participants' perceived sense of burden and lack of productivity when engaged with breathing exercises and video sessions.

METHODS

Stress levels were evaluated in a real-world data cohort using a behavioral health app for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform-based treatment followed users (N=490) who started with moderate and above levels of stress and completed at least 2 stress assessments. The levels of stress were tracked throughout the first 10 weeks. A piecewise mixed effects model was applied to model the trajectories of weekly stress mean scores in 2 time segments (1-6 weeks and 6-10 weeks). Next, a simple slope analysis was used for interpreting interactions probing the moderators: breathing exercises and video sessions. Piecewise mixed-effects models were also used to model the trajectories of specific perceived stress item rates in the stress questionnaire in the 2 segments (1-6 weeks and 6-10 weeks) and whether they are moderated by the relaxation engagements. Simple slope analysis was also used here for the interpretation of the interactions.

RESULTS

Analysis revealed a significant decrease in stress symptoms (β=-.25; 95% CI -0.32 to -0.17; P<.001) during the period of 1-6 weeks of app use that was maintained during the period of 6-10 weeks. Breathing exercises significantly moderated the reduction in stress symptoms during the period of 1-6 weeks (β=-.07; 95% CI -0.13 to -0.01; P=.03), while engagement in digital video sessions did not moderate stress scores. Engagement in digital video sessions, as well as breathing exercises, significantly moderated the reduction in perceived sense of burden and lack of productivity during weeks 1-6 and remained stable during weeks 6-10 on both items.

CONCLUSIONS

This study sheds light on the association between stress level reduction and specific components of engagement in a digital health app, breathing exercises, and cognitive behavioral therapy-based video sessions. Our findings provide a basis for further investigation of current and moderating factors that contribute to the personalization of digital intervention. In addition, results may aid in developing a more comprehensive understanding of how digital intervention tools work for mental health and for whom they are most effective.

Clinicians' experiences of learning to use eye movement desensitisation and reprocessing therapy with people with intellectual disabilities: A qualitative study

BACKGROUND

Eye Movement Desensitisation and Reprocessing therapy (EMDR) is a NICE recommended treatment for post-traumatic stress disorder within the general population. Ongoing research is now investigating the use of EMDR for individuals with intellectual disability. Alongside quantitative research efforts, it is beneficial to explore the qualitative experience of clinicians adopting EMDR in their practice. The current study interviewed newly trained EMDR therapists working in intellectual disability services.

METHOD

Participants (six Clinical Psychologists from an NHS learning disability service) had recently undertaken EMDR training as part of a wider randomised control trial (Trauma-AID). Interviews were qualitatively analysed using thematic analysis.

RESULTS

Three themes emerged; learning EMDR, conducting EMDR and external factors, with respect to clinicians' experiences.

CONCLUSIONS

Further research is needed to provide guidance and reassurance for clinicians currently using or hoping to use this therapy with people with intellectual disabilities.

To Use or Not to Use: Exploring Therapists' Experiences with Pre-Treatment EMA-Based Personalized Feedback in the TheraNet Project

BACKGROUND

Using idiographic network models in psychotherapy has been a growing area of interest. However, little is known about the perceived clinical utility of network models. The present study aims to explore therapists' experiences with network model-based feedback within the context of the TheraNet Project.

METHODS

In total, 18 therapists who had received network-based feedback for at least 1 patient at least 2 months prior were invited to retrospective focus groups. The focus group questions related to how participation in the study influenced the therapeutic relationship, how the networks were used, and what might improve their clinical utility. The transcribed focus groups were analyzed descriptively using qualitative content analysis.

RESULTS

Most therapists mentioned using the feedback to support their existingtheir case concept, while fewer therapists discussed the feedback directly with the patients. Several barriers to using the feedback were discussed, as well as various suggestions for how to make it more clinically useful. Many therapists reported skepticism with regards to research in the outpatient training center in general, though they were also all pleasantly surprised by being involved, having their opinions heard, and showing a readiness to adapt research to their needs/abilities.

CONCLUSIONS

This study highlights the gap between researchers' and therapists' perceptions about what useful feedback should look like. The TheraNet therapists' interest in adapting the feedback and building more informative feedback systems signals a general openness to the implementation of clinically relevant research. We provide suggestions for future implementations of network-based feedback systems in the outpatient clinical training center setting.

Specifying the Efficacy of Digital Therapeutic Tools for Depression and Anxiety: Retrospective, 2-Cohort, Real-World Analysis

BACKGROUND

Depression and anxiety are the main sources of work and social disabilities as well as health-related problems around the world. Digital therapeutic solutions using cognitive behavioral therapy have demonstrated efficacy in depression and anxiety. A common goal of digital health apps is to increase user digital engagement to improve outcomes. However, there is a limited understanding of the association between digital platform components and clinical outcomes.

OBJECTIVE

The aim of the study is to investigate the contribution of specific digital engagement tools to mental health conditions. We hypothesized that participation in coaching sessions and breathing exercises would be associated with a reduction in depression and anxiety.

METHODS

Depression and general anxiety symptoms were evaluated in real-world data cohorts using the digital health platform for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform-based treatment followed two cohorts of people: (1) users who started with moderate levels of depression and completed at least 2 depression assessments (n=519) and (2) users who started with moderate levels of anxiety and completed at least 2 anxiety assessments (n=474). Levels of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) were tracked throughout the first 16 weeks. A piecewise mixed-effects model was applied to model the trajectories of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 mean scores in 2 segments (1-6 weeks and 7-16 weeks). Finally, simple slope analysis was used for the interpretation of the interactions probing the moderators: coaching sessions and breathing exercises in both depression and anxiety cohorts.

RESULTS

Analysis revealed a significant decrease in depression symptoms (β=-.37, 95% CI -0.46 to 0.28; P≤.001) during the period of weeks 1-6 of app use, which was maintained during the period of 7-16 weeks. Coach interaction significantly moderated the reduction in depression symptoms during the period of weeks 1-6 (β=-.03, 95% CI -0.05 to -0.001; P=.02). A significant decrease in anxiety symptoms (β=-.41, 95% CI -0.50 to -0.33; P≤.001) was revealed during the period of 1-6 weeks, which was maintained during the period of 7-16 weeks. Breathing exercises significantly moderated the reduction in anxiety symptoms during the period of 1-6 weeks (β=-.07, 95% CI -0.14 to -0.01; P=.04).

CONCLUSIONS

This study demonstrated general improvement followed by a period of stability of depression and anxiety symptoms associated with cognitive behavioral therapy-based digital intervention. Interestingly, engagement with a coaching session but not a breathing exercise was associated with a reduction in depression symptoms. Moreover, breathing exercise but not engagement with a coaching session was associated with a reduction of anxiety symptoms. These findings emphasize the importance of using a personalized approach to behavioral health during digital health interventions.

Researching what we practice-The paradigm of systemic family research: Part 1

This is part 1 of two articles that focus on the ideological and philosophical preference regarding how to relate to and conduct research in the field of systemic couple and family therapy. Thus, this article outlines the theoretical groundwork for part 2 of "Researching what we practice" in the same journal. Research in certain areas of systemic couple and family therapy (CFT), such as that influenced by social constructionism and postmodernism, has a different epistemological tradition than in the natural sciences. Thus, only research from a narrow, selected spectrum of epistemologies has been incorporated as a key source in the knowledge base of systemic CFT. The consequence is that the field of postmodern systemic CFT risks promoting only a limited range of research designs and knowledge while excluding other designs and knowledge types, reasoning that these are less useful in clinical practice. The rationale behind this perspective is derived from ideology and philosophy rather than scientific criteria. Accordingly, in our field of study, different epistemological perspectives are easily viewed as dichotomous, thus causing professional gaps in our field. This tendency constrains the mutual exchange and development that are needed. We present a possible way out of this dichotomized deadlock, first and foremost by acknowledging - and encouraging the use of - the great variety and breadth of existing research and knowledge. Referring to the guiding principles of evidence-based practice, we argue that this would endow the systemic CFT therapist and researcher with a greater knowledge base and range of research methodologies. This could help improve the quality of treatment provided to our clients and enhance the legitimacy of postmodern systemic CFT as a branch of psychotherapy.

Praxisorientierte Forschung in der Psychotherapie

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.

Appraising psychotherapy case studies in practice-based evidence: introducing Case Study Evaluation-tool (CaSE)

Systematic case studies are often placed at the low end of evidence-based practice (EBP) due to lack of critical appraisal. This paper seeks to attend to this research gap by introducing a novel Case Study Evaluation-tool (CaSE). First, issues around knowledge generation and validity are assessed in both EBP and practice-based evidence (PBE) paradigms. Although systematic case studies are more aligned with PBE paradigm, the paper argues for a complimentary, third way approach between the two paradigms and their 'exemplary' methodologies: case studies and randomised controlled trials (RCTs). Second, the paper argues that all forms of research can produce 'valid evidence' but the validity itself needs to be assessed against each specific research method and purpose. Existing appraisal tools for qualitative research (JBI, CASP, ETQS) are shown to have limited relevance for the appraisal of systematic case studies through a comparative tool assessment. Third, the paper develops purpose-oriented evaluation criteria for systematic case studies through CaSE Checklist for Essential Components in Systematic Case Studies and CaSE Purpose-based Evaluative Framework for Systematic Case Studies. The checklist approach aids reviewers in assessing the presence or absence of essential case study components (internal validity). The framework approach aims to assess the effectiveness of each case against its set out research objectives and aims (external validity), based on different systematic case study purposes in psychotherapy. Finally, the paper demonstrates the application of the tool with a case example and notes further research trajectories for the development of CaSE tool.

Introducing SYPRENE: An International Practice Research Network for Strategic and Systemic Therapists and Researchers

SYPRENE, a new international Systemic Practice Research Network (PRN), has been established to fill the gap in practice-based research on the effectiveness and efficiency of strategic therapies. This article presents the rationale for the creation of SYPRENE and describes data collection methods, and the encoding system implemented within this PRN. More developments are expected in the recruitment of practitioners, the types of data collected, findings, and the implementation of SYPRENE in supervision, trainings, and professional schools.

Articulating the "So, What?" in Clinical Research: Insight from the M-CHOIR Group

With the academic culture of "publish or perish," authors must ensure that they are delivering high-quality data with a meaningful impact on clinical practice. Even for physician-scientists at the top of their fields, establishing the relevance of a study to clinical practice is a challenge. Thus, it is essential that research proposals ask questions that are clinically important, use appropriate methodologies, and examine outcomes that are relevant to both the physicians and the patients. The question of "so, what?" or in other words, "who cares?" is one that can make or break a study's impact on clinical practice. Researchers should use models such as PICOS (Population, Intervention, Comparison, Outcomes, and Study design) and FINER (Feasible, Interesting, Novel, Ethical, Relevant) and ask why readers will care about their study's findings before the study is conducted. By doing so, researchers can ensure the successful execution of their study and a meaningful impact of their findings, in both academia and clinical practice. This Special Topic article aims to guide researchers in producing relevant, impactful conclusions of their studies by providing input and resources from the Michigan Center for Hand Outcomes and Innovation (M-CHOIR) group.

Improving the reach of clinical practice guidelines: An experimental investigation of message framing on user engagement

Despite strong evidence for the efficacy of PTSD treatments, most affected individuals are not receiving these treatments, in part because they may not know that evidence-based treatments exist. The American Psychological Association published a website to disseminate information about their Clinical Practice Guideline for treating PTSD. In Study 1, Google Optimize was used in a field study to examine whether altering the subheadings to three of the website pages would increase site visitor engagement. On the main page and page describing treatments, no subheading alterations improved engagement. On the Patients and Families page, the subheading "say goodbye to symptoms" improved engagement on three outcome variables, including clicking a link to find a psychologist (though there were a small number of clicks). In a preregistered conceptual replication in a sample not actively seeking information about the PTSD guideline (N=578), results did not replicate. Results highlight challenges of evidence-based treatment information dissemination.

Program Evaluation of Group Transcending Self Therapy: An Integrative Modular Cognitive-Behavioral Therapy for Substance Use Disorders

OBJECTIVES

Substance Use Disorders (SUDs) are increasingly prevalent among Veterans. Effective interventions for SUDs that also meet the clinical reality of open treatment groups are needed. Transcending Self Therapy: Group Integrative Cognitive Behavioral Treatment (Group TST-I-CBT) was developed to address this need. Group TST-I-CBT is a four-module, 20-session treatment designed so that a person can enter at any point in the treatment. We conducted a program evaluation of Group TST-I-CBT for veterans with SUDs.

METHODS

Participants were N = 68 veterans enrolled in the 28-day Substance Abuse Residential Rehabilitation Treatment Program at an urban Veterans Administration Medical Center who received either Group TST-I-CBT (N = 34) or treatment-as-usual (TAU; N = 34). Medical records were reviewed and participant treatment outcome data was retrieved. Group TST-I-CBT clients completed a knowledge and feedback form at treatment completion.

RESULTS

Compared to TAU participants, Group TST-I-CBT participants were significantly less likely to have a positive urine drug screen (UDS) during treatment (17.6% versus 0%; P = .01) and within one month post-discharge (50% versus 17.6%; P = .04). Among Group TST-I-CBT clients, Quality of Life Inventory scores significantly increased by an average of 14 points from pre- to post-treatment, t(15) = -3.31, P = .005, d = 0.83. Group TST-I-CBT clients displayed cognitive-behavioral therapy knowledge (mean correct answers ranged from 92%-100%) and rated Group TST-I-CBT as helpful, understandable, and useful (mean scores ranged from 9.3-9.6 out of 10).

CONCLUSIONS

These preliminary data indicate that Group TST-I-CBT may be an effective group therapy as part of SUD treatment. A formal randomized controlled trial of Group TST-I-CBT may be warranted.

Blended Care-Cognitive Behavioral Therapy for Depression and Anxiety in Real-World Settings: Pragmatic Retrospective Study

Background

The past few decades saw considerable advances in research and dissemination of evidence-based psychotherapies, yet available treatment resources are not able to meet the high need for care for individuals suffering from depression or anxiety. Blended care psychotherapy, which combines the strengths of therapist-led and internet interventions, can narrow this gap and be clinically effective and efficient, but has rarely been evaluated outside of controlled research settings.

Objective

This study evaluated the effectiveness of a blended care intervention (video-based cognitive behavior therapy and internet intervention) under real-world conditions.

Methods

This is a pragmatic retrospective cohort analysis of 385 participants with clinical range depression and/or anxiety symptoms at baseline, measured using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), who enrolled in blended care psychotherapy treatment. Participants resided in the United States and had access to the blended care intervention as a mental health benefit offered through their employers. Levels of depression and anxiety were tracked throughout treatment. Hierarchical linear modeling was used to examine the change in symptoms over time. The effects of age, gender, and providers on participants’ symptom change trajectories were also evaluated. Paired sample t-tests were also conducted, and rates of positive clinical change and clinically significant improvement were calculated.

Results

The average depression and anxiety symptoms at 6 weeks after the start of treatment were 5.94 and 6.57, respectively. There were significant linear effects of time on both symptoms of depression and anxiety (β=–.49, P<.001 and β=–.64, P<.001). The quadratic effect was also significant for both symptoms of depression and anxiety (β=.04, P<.001 for both), suggesting a decelerated decrease in symptoms over time. Approximately 73% (n=283) of all 385 participants demonstrated reliable improvement, and 83% (n=319) recovered on either the PHQ-9 or GAD-7 measures. Large effect sizes were observed on both symptoms of depression (Cohen d=1.08) and of anxiety (d=1.33).

Conclusions

Video blended care cognitive behavioral therapy interventions can be effective and efficient in treating symptoms of depression and anxiety in real-world conditions. Future research should investigate the differential and interactive contribution of the therapist-led and digital components of care to patient outcomes to optimize care.

Status of use of protease inhibitors for the prevention and treatment of pancreatitis after endoscopic retrograde cholangiopancreatography: An epidemiologic analysis of the evidence-practice gap using a health insurance claims database

Existing evidence suggests that protease inhibitors (PIs) used to prevent or treat pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) are ineffective, and their use is not recommended by clinical practice guidelines. However, in Japan, PIs are administered with the aim to prevent or treat post-ERCP pancreatitis. This study aimed to clarify the gap between guideline recommendations and contents of practice. We used the health insurance claims database of Japan Medical Data Center. Among patients who had undergone ERCP, those with acute pancreatitis or post-ERCP pancreatitis recorded in claims as disease names were defined as post-ERCP pancreatitis patients. The study period was divided into three terms according to the date of publication of clinical practice guidelines for acute pancreatitis. Among 2,945 patients who had undergone ERCP, 2,847 were eligible for analysis. Of these, 1,375 (48.3%) patients had claims with pancreatitis recorded as the disease name; PIs were prescribed to 1,238 (90.0%). Rates of prescription of PIs were 72.3% in 2005-07, 70.9% in 2008-09, and 83.6% in 2010-15, showing a significant increase (p < 0.001). In conclusion, PIs are administered in clinical practice in Japan for the purpose of preventing or treating pancreatitis, with an increasing trend in prescription in recent years.

Evidence for the Feasibility of Person-Specific Ecological Momentary Assessment Across Diverse Populations and Study Designs

Clinical psychological science has seen an exciting shift toward the use of person-specific (idiographic) approaches to studying psychopathology and change in treatment at the level of the individual. One commonly used method in idiographic research is ecological momentary assessment (EMA). EMA offers a way to sample individuals intensively – often multiple times per day – as they go about their lives. While these methods offer benefits such as greater ecological validity and streamlined data collection, many share concerns about their feasibility across diverse clinical populations. To investigate the feasibility of using EMA to study psychological processes idiographically both in- and out of the context of therapy, the present study aggregated participants across seven studies spanning diverse clinical and community populations (N = 496), all of which utilized an idiographic EMA approach to study symptoms of psychopathology (e.g., PTSD, mood and anxiety, substance abuse). In a series of linear regression models, participant and study design characteristics were used to predict compliance with EMA surveys. Across study designs, we found that (1) participants were willing to report on symptoms and mechanisms relating to a wide range of psychopathological domains; (2) on average, participants completed 82.21% (SD = 16.34%) of all EMA surveys; and (3) compliance with EMA surveys was not significantly related to participant demographics, psychological diagnosis, personality characteristics, or most study characteristics (e.g., number of surveys per day). These findings suggest feasibility of idiographic EMA for collecting the data needed to understand psychopathology and change in treatment at the level of the individual.

Association of rs7688285 allelic variation coding for GLRB with fear reactivity and exposure-based therapy in patients with panic disorder and agoraphobia

The gene coding for glycine receptor β subunits (GLRB) has been found to be related to panic disorder and agoraphobia (PD/AG) and to be associated with altered insular BOLD activation during fear conditioning, as an intermediate phenotype of defensive system reactivity in healthy subjects. In a multicenter clinical trial on PD/AG patients we investigated in three sub-samples whether GLRB allelic variation (A/G; A-allele identified as «risk») in the single nucleotide polymorphism rs7688285 was associated with autonomic (behavioral avoidance test BAT; n = 267 patients) and neural (differential fear conditioning; n = 49 patients, n = 38 controls) measures, and furthermore with responding towards exposure-based cognitive behavioral therapy (CBT, n = 184 patients). An interaction of genotype with current PD/AG diagnosis (PD/AG vs. controls; fMRI data only) and their modification after CBT was tested as well. Exploratory fMRI results prior to CBT, revealed A-allele carriers irrespective of diagnostic status to show overall higher BOLD activation in the hippocampus, motor cortex (MC) and insula. Differential activation in the MC, anterior cingulate cortex (ACC) and insula was found in the interaction genotype X diagnosis. Differential activation in ACC and hippocampus was present in differential fear learning. ACC activation was modified after treatment, while no overall rs7688285 dependent effect on clinical outcomes was found. On the behavioral level, A-allele carriers showed pronounced fear reactivity prior to CBT which partially normalized afterwards. In sum, rs7688285 variation interacts in a complex manner with PD/AG on a functional systems level and might be involved in the development of PD/AG but not in their treatment.

In Their Own Words: Clinician Experiences and Challenges in Administering Evidence-Based Treatments for PTSD in the Veterans Health Administration

The aim of the present study was to increase the understanding of clinician experiences with administering two evidence-based psychotherapies (EBPs) for PTSD (Cognitive Processing Therapy and Prolonged Exposure therapy) in the Veterans Affairs Healthcare System (VA). The study assessed clinician perceptions through the use of two, one-hour focus groups and employed a rigorous data analysis approach, Consensual Qualitative Research. Clinicians who work in an outpatient PTSD clinic at a New England VA, and who routinely administer EPBs for PTSD, participated in the study. Results were categorized into seven domains by the coding team, including 1) EBP Strengths, 2) EBP Weaknesses, 3) Challenges Specific to the Veteran Population, 4) Perceived EBP Effectiveness, 5) Active Ingredients for Treating PTSD, 6) Treatment Structure and Process, and 7) Suggested Changes/Improvements to EBPs. These domains are discussed in detail, with several core ideas falling under each domain. Operational definitions and representative quotes are provided. Overall, clinicians provided a balanced perspective and identified both strengths and weaknesses of the EBPs for PTSD. They identified several challenges in applying these treatments to veteran populations, and shared their beliefs about treatment effectiveness, how they use these treatments in their clinical practice, and how they would change the treatments if given an opportunity to do so. In this way, the study offers a small but important step in attempting to address the science-practice gap related to EBP for PTSD implementation efforts in the VA.

A review of translational medicine. The future paradigm: how can we connect the orthopedic dots better?

INTRODUCTION

Patients with complex medical and surgical problems often travel great distances to prestigious university medical centers in search of solutions and in some cases for nothing more than a diagnosis of their condition. Translational medicine (TM) is an emerging method and process of facilitating medical advances efficiently from the scientist to the clinician. Most established clinicians and those in training know very little about this new discipline. The purpose of this article is to illustrate TM in varied scientific, medical and surgical fields.

MATERIALS AND METHODS

Anecdotal events in medicine and orthopaedics based upon a practicing orthopaedic surgeon's training and clinical experience are presented.

RESULTS

TM is rapidly assuming a greater presence in the medical community. The National Institute of Health (NIH) recognizes this discipline and has funded TM projects. Numerous institutions in Europe and the USA offer advanced degrees in TM. Finally there is a European Society for Translational Medicine (EUTMS), an International Society for Translational Medicine, and an Academy of Translational Medical Professionals (ATMP).

DISCUSSION

The examples of TM presented in this article support the argument for the formation of more TM networks on the local and regional levels. The need for increased participation of researchers and clinicians requires further study to identify the economic and social impact of TM.

CONCLUSIONS

The examples of TM presented in this article support the argument for the formation of more TM networks on the local and regional levels. Financial constraints for TM can be overcome by pooling government, academic, private, and industry resources in an organized fashion with oversight by a lead TM researcher.

From Efficacy to Global Impact: Lessons Learned About What Not to Do in Translating Our Research to Reach

Although members of the Association for Behavioral and Cognitive Therapies have made significant strides toward the collective goals outlined in our mission statement, we routinely acknowledge that our ability to develop empirically supported treatments exceeds our success in improving dissemination and implementation of said interventions. Further, as noted by Kazdin and Blase (2011), even if we succeeded in having every clinician worldwide administer our best treatments with excellent competency, we still would be unsuccessful in markedly impacting the worldwide burden of mental illness because most treatments require intensive labor by expensive providers. To this end, Kazdin and Blase and others call for increased use of alternative strategies. Examples include increased attention toward prevention; use of lower-cost, simplified interventions; task shifting; train-the-trainer models; community participatory research methodology; and identification of novel funding sources. The Body Project is an empirically supported, cognitive dissonance-based prevention intervention that targets body image, a well-established risk factor for eating disorders, negative affect, unhealthy weight control behaviors, smoking behavior, and decreased physical activity. Supported by a global village of researchers, community activists, and organizational partners, the Body Project is currently being implemented in 125 countries. The aim of this paper is to share lessons our team has learned in taking a prevention intervention from early testing to widespread implementation and connect these back to broader conversations occurring in our field regarding the importance of scalability and new directions in improving global mental health.

Training Psychiatry Residents in Psychotherapy: The Role of Manualized Treatments

Evidence-based treatment and manualized psychotherapy have a recent but rich history. As interest and research have progressed, defining the role of treatment manuals in resident training and clinical practice has become more important. Although there is not a universal definition of treatment manual, most clinicians and researchers agree that treatment manuals are an essential piece of evidence-based therapy, and that despite several limitations, they offer advantages in training residents in psychotherapy. Requirements for resident training in psychotherapy have changed over the years, and treatment manuals offer a simple and straightforward way to meet training requirements. In a search limited to only depression, two treatment manuals emerged with the support of research regarding both clinical practice and resident training. In looking toward the future, it will be important for clinicians to remain updated on further advances in evidence based manualized treatment as a tool for training residents in psychotherapy, including recent developments in online and smartphone based treatments.

Introduction: Applying Clinical Psychological Science to Practice

Mental illness is a prevalent and extraordinarily complex phenomenon. Psychologists have developed distinct approaches toward understanding and treating mental illness, rooted in divergent epistemology. This introduction to the Special Issue on Clinical Psychological Science and Practice provides a brief overview of the scientist-practitioner gap, and explores one step (of many) toward bridging this divide. Seven compelling case illustrations featured in this Special Issue apply empirical findings to case formulation, treatment selection, and assessment across complex and varied clinical presentations. This issue thereby demonstrates the feasibility of integrating research and clinical expertise in mental healthcare.

Use of clinical practice guidelines by dentists: findings from the Japanese dental practice-based research network

RATIONALE, AIMS AND OBJECTIVES

The objectives of this study were to: (1) examine differences in the use of dental clinical practice guidelines among Japanese dentists, and (2) identify characteristics associated with the number of guidelines used by participating dentists.

METHODS

We conducted a cross-sectional study consisting of a questionnaire survey in Japan between July 2014 and May 2015. The study queried dentists working in outpatient dental practices who are affiliated with the Dental Practice-Based Research Network Japan (n = 148). They were asked whether they have used each of 15 Japanese dental clinical guidelines. Associations between the number of guidelines used by participants and specific characteristics were analysed via negative binomial regression analysis.

RESULTS

The mean number of guidelines used by participating dentists was 2.5 ± 2.9 [standard deviation (SD)]. Rate of use of guidelines showed substantial variation, from 5% to 34% among dentists. The proportion of dentists that used guidelines was the highest among oral medicine specialists, who had the highest proportion for 10 of 15 guidelines. Negative binomial regression analysis identified three factors significantly associated with the number of guidelines used: 'years since graduation from dental school', 'specialty practice' and 'practice busyness'.

CONCLUSIONS

These results suggest that the use of clinical practice guidelines by Japanese dentists may still be inadequate. Training in the use of the guidelines could be given to dental students as undergraduate education and to young clinicians as continuing education.

Cognitive Behavioral and Psychodynamic Therapies: Points of Intersection and Divergence

Cognitive behavioral therapy (CBT) and psychodynamic therapy (PDT) are two major paradigms in the mental health care field. The present article reviews broad similarities and differences between each tradition while acknowledging that such generalizations may overlook heterogeneity within each. However, it is believed that a comparison between CBT and PDT is beneficial in dispelling myths about each tradition, fostering dialogue, encouraging further scholarship and research. While not an exhaustive account, this article will examine how CBT and PDT differ in how they view several topics such as the unconscious, the therapeutic alliance, the role of homework, symptom reduction, and therapeutic heuristics. Commentary is also offered on how research may be more effectively and collaboratively integrated with clinical work from both traditions. Future directions for partnership and improving mental health treatments are also discussed.

Developing Emotion-Based Case Formulations: A Research-Informed Method

OBJECTIVES

New research-informed methods for case conceptualization that cut across traditional therapy approaches are increasingly popular. This paper presents a trans-theoretical approach to case formulation based on the research observations of emotion.

METHODS

The sequential model of emotional processing (Pascual-Leone & Greenberg, 2007) is a process research model that provides concrete markers for therapists to observe the emerging emotional development of their clients. We illustrate how this model can be used by clinicians to track change and provides a 'clinical map,' by which therapist may orient themselves in-session and plan treatment interventions.

RESULTS

Emotional processing offers as a trans-theoretical framework for therapists who wish to conduct emotion-based case formulations. First, we present criteria for why this research model translates well into practice. Second, two contrasting case studies are presented to demonstrate the method.

CONCLUSIONS

The model bridges research with practice by using client emotion as an axis of integration. Key Practitioner Message Process research on emotion can offer a template for therapists to make case formulations while using a range of treatment approaches. The sequential model of emotional processing provides a 'process map' of concrete markers for therapists to (1) observe the emerging emotional development of their clients, and (2) help therapists develop a treatment plan. Copyright © 2016 John Wiley & Sons, Ltd.

Dentists' decisions to conduct caries risk assessment in a Dental Practice-Based Research Network

OBJECTIVES

(i) To quantify the importance that dentists place on caries risk factors when developing a caries treatment plan and (ii) to test the hypothesis that the ratings of importance for specific factors are significantly associated with whether or not the dentist performs caries risk assessment (CRA).

METHODS

This study used a cross-sectional study design consisting of a questionnaire survey. The study queried dentists who worked in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan (JDPBRN), which seeks to engage dentists in investigating research questions and sharing experiences and expertise (n = 282). Participants (n = 189) were asked to rate the importance of caries risk factors when developing a caries treatment plan in both adult and pediatric patients.

RESULTS

Oral hygiene status was rated as the most important risk factor when developing a treatment plan in both adult and pediatric patients, whereas the use of fluorides was rated as the least important. Results of multiple logistic regression analysis showed that the odds ratios for the decision to perform CRA in the adult patient for past caries experience and use of fluorides were 2.61 (95% confidence interval [CI]: 1.29-5.29) and 1.85 (95% CI: 1.12-3.04), respectively, whereas that for oral hygiene was 3.84 (95% CI: 1.15-12.79) and use of fluorides 1.79 (95% CI: 1.06-3.03) in the pediatric patient.

CONCLUSIONS

These results suggest that enhancing dentists' concept of the importance of current use of fluorides when developing a treatment plan may increase the percentage of dentists who conduct CRA in both adult and pediatric patients (clinicaltrials.gov registration number: NCT01680848).

Patient age and dentists' decisions about occlusal caries treatment thresholds

OBJECTIVES

This study was performed to 1) quantify dentists' treatment thresholds for occlusal primary caries; 2) determine if the patient's age affects dentists' decisions to surgically treat these carious lesions; and 3) test the hypothesis that patients', dentists', and practices' characteristics are significantly associated with surgical enamel intervention.

METHODS

The study used a cross-sectional design consisting of a questionnaire survey in Japan. This study queried dentists working in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan (JDPBRN), which aims to allow dentists to investigate research questions and share experiences and expertise (n=282). Participants were asked whether they would surgically intervene in a series of cases depicting occlusal caries. Each case included a photograph of an occlusal surface displaying typical characteristics of caries penetration and written descriptions of adult and pediatric patients at high caries risk.

RESULTS

In a case of a carious lesion within inner enamel, the proportion of dentists who indicated surgical intervention was significantly higher in adult patients (48%) when compared with pediatric patients (34%; p<0.01). Logistic regression analysis showed that using a dental explorer for the diagnosis of primary occlusal caries, type of practice, practice busyness, and percentage of patients who self-pay were significantly associated with dentists' decisions to intervene surgically into the inner enamel carious lesion.

CONCLUSIONS

These findings demonstrate that more than one-third of participants chose to intervene surgically into inner enamel carious lesions, and patients' age affects dentists' decisions about when to intervene surgically (clinicaltrials.gov registration number NCT01680848).

Remote "hovering" with individuals with psychotic disorders and substance use: feasibility, engagement, and therapeutic alliance with a text-messaging mobile interventionist

OBJECTIVE

People with serious mental illnesses and substance abuse problems (i.e., dual diagnosis) constitute a particularly challenging and costly clinical group. This study evaluated the feasibility and acceptability of a novel model of care in which a mobile interventionist used mobile phone text messaging to remotely monitor and provide daily support to individuals with psychotic disorders and substance use.

METHODS

Seventeen participants with dual diagnosis were enrolled in a 12-week single-arm trial. A clinical social worker served as the mobile interventionist and sent daily text messages to participants' privately owned mobile phones to assess their medication adherence and clinical status. The mobile interventionist provided text-message feedback and support and suggested various coping strategies flexibly, in response to participants' replies to prompts. At the end of the trial, participants completed a usability and satisfaction measure and two self-rated measures of therapeutic alliance with their clinicians. In one version, participants rated their relationship with their mobile interventionist; in the second version, they rated their relationship with their community-based treatment team.

RESULTS

Participants received an average of 139 text messages (SD = 37.5) each from the mobile interventionist over the 12-week trial. On average, participants responded to 87% of the mobile interventionist's messages that required a reply. More than 90% of participants thought the intervention was useful and rewarding and that it helped them be more effective and productive in their lives. Participants' assessments of their relationship with the mobile interventionist were positive. Paired-sample t-test found that the therapeutic alliance ratings participants provided for their mobile interventionist were significantly higher than those provided for their community-based treatment team clinicians, who they met with regularly.

CONCLUSIONS

Our findings suggest that text-message "hovering" can be conducted successfully with individuals with psychotic disorders and substance abuse. Developing a cadre of mobile interventionists who are specifically trained on how to engage patients via mobile devices while adhering to ethical guidelines and regulatory standards may be an effective way to strengthen service delivery models, improve patient outcomes, and reduce costs.

The divide between "evidenced-based" approaches and practitioners of traditional theories of family therapy

Evidenced-based approaches continue to grow in the field of family therapy. However, practicing family therapists do not always embrace these approaches. In this article, we explore factors contributing to practitioners' concerns with evidence-based treatments and suggest a broader, more clinically palatable view of evidenced-based treatment. We also suggest how family therapy researchers, practitioners, and educators might begin to close the researcher-clinician divide in the best interest of all concerned.

CONVERGENCE OF DEPRESSION AND ANXIETY SYMPTOMS IN FRIENDSHIP DYADS

Despite psychometric rationale to include multiple informants, psychological assessment typically involves data collected from the patient (target) only, particularly with regard to depressive and anxious symptomatology. This study addressed this gap in the literature by assessing convergence between targets and their close friends (informants) in an ethnically diverse sample of young adults. One hundred and thirty-nine friendship dyads completed a packet of questionnaires including different versions administered to the targets and informants, with targets completing the standard questionnaire battery focused on their own symptoms and informants completing questionnaires on their view of the target participants' symptoms, rather than their own characteristics. Measures were included to assess a wide range of symptomatology, including behavioral, cognitive, and physiological symptoms of anxiety and depression. The target-informant correlations were largely significant and of small-to-medium magnitude. In addition, target-informant agreement was higher in more visible symptoms (e.g., behavioral) than in less visible symptoms (e.g., physiological) of anxiety and depression. Interestingly, level of closeness in the relationship did not influence the magnitude of correlations. Implications for future research and integration into clinical assessment practices are discussed.

The Technology of Measurement Feedback Systems

Usual care in the community is far from optimal. Sufficient evidence exists that dropout rates are significant, treatment is effective for only a small proportion of clients, and that the translation of evidence-based treatments to the real world is problematic. Technology has been shown to be helpful in health care in improving the effectiveness of treatment. A relatively new technology being used in mental health is measurement feedback systems (MFSs). MFSs are particularly applicable to couple and family psychology (CFP) because of its ability to provide information on the multiple perspectives involved in treatment. The Contextualized Feedback Systemstm (CFS®), developed at Vanderbilt University is used as an example of what can be accomplished with an MFS. The advantages and limitations of this technology are described as well as the anticipated reimbursement requirements that mental health services will need.

Restorative treatment thresholds for proximal caries in dental PBRN

This study was conducted to assess caries treatment thresholds among Japanese dentists and to identify characteristics associated with their decision to intervene surgically in proximal caries lesions within the enamel. Participants (n = 189) were shown radiographic images depicting interproximal caries and asked to indicate the lesion depth at which they would surgically intervene in both high- and low-caries-risk scenarios. Differences in treatment thresholds were then assessed via chi-square tests, and associations between the decision to intervene and dentist, practice, and patient characteristics were analyzed via logistic regression. The proportion of dentists who indicated surgical intervention into enamel was significantly higher in the high-caries-risk scenario (73.8%, N = 138) than in the low-caries-risk scenario (46.5%, N = 87) (p < 0.001). In multivariate analyses for a high-caries-risk scenario, gender of dentist, city population, type of practice, conducting caries-risk assessment, and administering diet counseling were significant factors associated with surgical enamel intervention. However, for a low-caries-risk scenario, city population, type of practice, and use of a dental explorer were the factors significantly associated with surgical enamel intervention. These findings demonstrate that restorative treatment thresholds for interproximal primary caries differ by caries risk. Most participants would restore lesions within the enamel for high-caries-risk individuals.

An opportunity to bridge the gap between clinical research and clinical practice: implications for clinical training

Clinical researchers and clinical practitioners share a goal of increasing the integration of research and clinical practice, which is reflected in an evidence-based practice (EBP) approach to psychology. The EBP framework involves the integration of research findings with clinical expertise and client characteristics, values, and preferences, and consequently provides an important foundation for conducting clinically relevant research, as well as empirically based and clinically sensitive practice. Given the critical role that early training can play in the integration of science and practice and in promoting the future of the field, the present article addresses predoctoral training programs as a context for adopting an EBP approach to clinical work. We address training in the three components of EBP and provide suggestions for curriculum development and practicum training that we hope will contribute to bridging the gap between research and practice.

A translational model of research-practice integration

We propose a four-level, recursive Research-Practice Integration framework as a heuristic to (a) integrate and reflect on the articles in this Special Section as contributing to a bidirectional bridge between research and practice, and (b) consider additional opportunities to address the research-practice gap. Level 1 addresses Treatment Validation studies and includes an article by Lochman and colleagues concerning the programmatic adaptation, implementation, and dissemination of the empirically supported Coping Power treatment program for youth aggression. Level 2 translation, Training in Evidence-Based Practice, includes a paper by Hershenberg, Drabick, and Vivian, which focuses on the critical role that predoctoral training plays in bridging the research-practice gap. Level 3 addresses the Assessment of Clinical Utility and Feedback to Research aspects of translation. The articles by Lambert and Youn, Kraus, and Castonguay illustrate the use of commercial outcome packages that enable psychotherapists to integrate ongoing client assessment, thus enhancing the effectiveness of treatment implementation and providing data that can be fed back to researchers. Lastly, Level 4 translation, the Cross-Level Integrative Research and Communication, concerns research efforts that integrate data from clinical practice and all other levels of translation, as well as communication efforts among all stakeholders, such as researchers, psychotherapists, and clients. Using a two-chair technique as a framework for his discussion, Wolfe's article depicts the struggle inherent in research-practice integration efforts and proposes a rapprochement that highlights advancements in the field.