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Barry TJ, Hallford DJ. Transdiagnostic and transtherapeutic strategies for optimising autobiographical memory. Behav Res Ther 2024; 180:104575. [PMID: 38852230 DOI: 10.1016/j.brat.2024.104575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/14/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
Our memories for past personally experienced autobiographical events play an important role in therapy, irrespective of presenting issue, diagnoses or therapeutic modality. Here, we summarise evidence for how autobiographical memory abilities can influence our mental health and the relevance of this for the treatment of mental health problems. We then guide the reader through principles and strategies for optimising autobiographical memory within treatment. We ground these recommendations within research for stand-alone interventions for improving autobiographical memory and from studies of how to support the formation and retrieval of therapeutic memories. Options are given for clinicians to guide clients in improving retrieval of autobiographical memories within treatment, for improving autobiographical memory for the therapeutic experience itself, and for creating improvements in autobiographical memory that endure post-treatment. We also provide worksheets for clinicians to use within treatment.
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Affiliation(s)
- T J Barry
- Department of Psychology, University of Bath, Bath, UK.
| | - D J Hallford
- School of Psychology, Deakin University, Melbourne, Australia
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2
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Holder N, Ranney RM, Bernhard PA, Holliday R, Vogt D, Hoffmire CA, Blosnich JR, Schneiderman AI, Maguen S. Which veterans with PTSD are most likely to report being told of their diagnosis? J Psychiatr Res 2024; 170:158-166. [PMID: 38147692 DOI: 10.1016/j.jpsychires.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
Veterans who do not know about their posttraumatic stress disorder (PTSD) diagnosis experience a fundamental barrier to accessing effective treatment. Little is known about the characteristics that influence veterans' PTSD diagnosis knowledge (i.e., report of being told they have a PTSD diagnosis by a healthcare provider). Veterans who met probable and provisional criteria for PTSD on the self-report PTSD checklist for DSM-5 were identified from the Comparative Health Assessment Interview Research Study (n = 2335). Weighted logistic regression was performed to identify demographic variables, clinical characteristics, and social determinants of health (e.g., economic instability, homelessness, healthcare coverage) associated with PTSD diagnosis knowledge among post-9/11 veterans. Approximately 62% of veterans with probable and provisional PTSD had PTSD diagnosis knowledge. Predictors with the strongest associations included another mental health diagnosis (OR = 6.10, CI95:4.58,8.12) and having Veterans Affairs (VA) healthcare coverage (OR = 2.63, CI95:1.97,3.51). Veterans with combat or sexual trauma were more likely to have PTSD diagnosis knowledge than those with different trauma types. Results suggest veterans with VA healthcare coverage and military-related trauma are more likely to be informed by a healthcare professional about a PTSD diagnosis. Further research is needed to improve PTSD diagnosis knowledge for those with non-military-related trauma and those without VA healthcare coverage.
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Affiliation(s)
- Nicholas Holder
- San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco School of Medicine, United States.
| | - Rachel M Ranney
- San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco School of Medicine, United States; Sierra Pacific Mental Illness Research, Education, and Clinical Center, United States
| | - Paul A Bernhard
- Health Outcomes Military Exposures Epidemiology Program, Patient Care Services, U.S. Department of Veterans Affairs, United States
| | - Ryan Holliday
- Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, United States; University of Colorado Anschutz Medical Campus, Department of Psychiatry, United States
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, United States; Boston University School of Medicine, United States
| | - Claire A Hoffmire
- Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, United States; University of Colorado Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, United States
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, United States; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, United States
| | - Aaron I Schneiderman
- Health Outcomes Military Exposures Epidemiology Program, Patient Care Services, U.S. Department of Veterans Affairs, United States
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco School of Medicine, United States; Sierra Pacific Mental Illness Research, Education, and Clinical Center, United States
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Parrish EM, Quynh A, Scott V, Chalker SA, Chang C, Kamarsu S, Twamley EW, Depp CA. Suicide Safety Plan Self-knowledge in Serious Mental Illness: Psychiatric Symptom Correlates and Effects of Brief Intervention. Community Ment Health J 2023; 59:1639-1646. [PMID: 37340170 DOI: 10.1007/s10597-023-01155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
Psychiatric symptoms experienced by people with serious mental illness (SMI; schizophrenia, bipolar and other psychotic disorders) may impact suicide safety planning. This study examined safety plan self-knowledge, or an individual's own knowledge and awareness of their safety plan, in a sample of people with SMI. Participants (N = 53) with SMI at elevated risk of suicide completed a 4-session intervention that included safety plans, with one intervention group that included mobile augmentation. Self-knowledge was assessed from previous safety plans at 4-, 12- and 24-weeks. Fewer warning signs generated was correlated with greater psychiatric symptoms (r = - .306, p = .026) and suicidal ideation (r = - .298, p = .030). Fewer coping strategies generated was correlated with greater suicidal ideation (r = .- 323, p = .018). Preliminarily, there was greater self-knowledge of warning signs over time among participants in the mobile intervention. These preliminary findings highlight the relationship of safety plan self-knowledge to symptoms and suggest that mobile augmentation of safety planning may be beneficial. Trial Registration: NCT03198364.
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Affiliation(s)
- Emma M Parrish
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
| | - Avery Quynh
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Vanessa Scott
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Samantha A Chalker
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Cindy Chang
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Snigdha Kamarsu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
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Dolsen EA, Dong L, Harvey AG. Transdiagnostic Sleep and Circadian Intervention for Adolescents Plus Text Messaging: Randomized Controlled Trial 12-month Follow-up. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:750-762. [PMID: 34936528 PMCID: PMC9213566 DOI: 10.1080/15374416.2021.1978295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C) was developed to improve sleep and circadian functioning in adolescents. This study examined the 12-month effects for TranS-C compared with psychoeducation (PE). We also investigated whether a text messaging intervention can promote maintenance of treatment effects. METHOD At the baseline, adolescents (58% female, average age = 14.8 years) with an eveningness chronotype were randomized to TranS-C (n = 89) or PE (n = 87). At 6-month follow-up, participants were randomized to receive text messages that had repeated treatment information (n = 47), text messages that prompted the recall of treatment information (n = 50), or no text messages (n = 47). RESULTS Relative to PE, TranS-C was associated with a reduced eveningness (b = 2.06, p = .005, d = 0.29) from the baseline to a 12-month follow-up. TranS-C treatment effects, relative to PE, were augmented by receiving text messages, compared to no text messages, for eveningness from baseline to 12-month follow-up (b = 1.38, p = .008, d = 0.28) and from 6- to 12-month follow-up (b = 1.07, p = .046, d = 0.21). Neither TranS-C nor text messages were significantly associated with other primary outcomes. TranS-C and text messages were significantly associated with improvements on selected secondary sleep and health outcomes through follow-up. CONCLUSIONS For adolescents with an eveningness chronotype, improved sleep and circadian functioning on selected outcomes were maintained over 12 months for TranS-C compared with PE. Text messages boosted the effects of TranS-C through 12-month follow-up.
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Affiliation(s)
- Emily A. Dolsen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
- Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System. San Francisco, CA, USA
| | - Lu Dong
- RAND Corporation, Santa Monica, CA, USA
| | - Allison G. Harvey
- Department of Psychology, University of California, Berkeley, CA, Berkeley, CA, USA
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Zieve GG, Sarfan LD, Dong L, Tiab SS, Tran M, Harvey AG. Cognitive Therapy-as-Usual versus Cognitive Therapy plus the Memory Support Intervention for adults with depression: 12-month outcomes and opportunities for improved efficacy in a secondary analysis of a randomized controlled trial. Behav Res Ther 2023; 170:104419. [PMID: 37879246 PMCID: PMC11025560 DOI: 10.1016/j.brat.2023.104419] [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: 05/04/2023] [Revised: 08/31/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Patient memory for treatment is emerging as an important transdiagnostic mechanism of treatment outcomes. However, patient memory for treatment is limited. The Memory Support Intervention was developed to improve patient memory for treatment and thereby strengthen treatment outcomes. In this secondary analysis, the primary, preregistered aim was to test the 12-month follow-up outcomes of the Memory Support Intervention when used with cognitive therapy (CT + MS) for major depressive disorder, relative to CT-as-usual. The secondary, exploratory aim was to investigate opportunities to improve efficacy of the Memory Support Intervention. METHOD Adults (N = 178) with major depressive disorder were randomized to CT-as-usual or CT + MS. Therapist use of memory support and patient memory for treatment, depression symptoms, and overall functioning were measured in blind assessments. RESULTS Findings did not support differences between treatment conditions at 12-month follow-up. Therapists used memory support strategies with a narrow subset of treatment contents, and similarly, patients recalled a narrow subset of treatment contents. CONCLUSIONS The findings highlight ways to strengthen the efficacy of the Memory Support Intervention, such as applying memory support strategies across a wider variety of treatment contents, which in turn, may boost patient recall and outcomes.
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Affiliation(s)
- Garret G Zieve
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Laurel D Sarfan
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Lu Dong
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Sondra S Tiab
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Melanie Tran
- University of Illinois at Chicago, 1747 W. Roosevelt Road, Chicago, IL, 60612, USA.
| | - Allison G Harvey
- University of California, Department of Psychology, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA.
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Larsen SE, Hooyer K, Kehle-Forbes SM, Hamblen J. Patient experiences in making PTSD treatment decisions. Psychol Serv 2023:2024-18627-001. [PMID: 37856390 PMCID: PMC11026293 DOI: 10.1037/ser0000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Although there is a range of effective posttraumatic stress disorder (PTSD) treatments, the number of patients who receive those treatments is disappointingly low (Finley et al., 2015; Maguen et al., 2018). Very little research has examined the patient experience of deciding on a PTSD treatment option and how that experience influences treatment preference and selection. In a sample of 12 veterans and 10 providers, we recorded the sessions in which providers discussed PTSD treatment options with their patients and then interviewed patients to ask their impressions of those same sessions. Specifically, using qualitative analysis, we sought to understand (a) patient preferences and experiences of choosing a PTSD treatment option, (b) what information patients retain from treatment planning sessions, and (c) why patients chose a given treatment. Almost all the patients in this sample chose an evidence-based psychotherapy but could remember little about the options afterward. Patients reported that providers presented options neutrally and that they made shared decisions with their providers. Most could talk through their reasons for coming to a decision and felt comfortable with the decision, but decisions were often made heuristically rather than deliberatively. Surprisingly, a few patients had a hard time explaining why they chose a specific treatment, were not conscious of their exact reasons for choosing a treatment, or seemed unable to remember why they chose a treatment. We also noticed subtle ways in which providers' discussions influenced treatment choice. Implications for practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Sadie E. Larsen
- National Center for PTSD, Executive Division, 215 N. Main St., White River Junction, VT 05009
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, 8701 W Watertown Plank Rd., Wauwatosa, WI 53226
- Milwaukee VA Medical Center, 5000 W. National Avenue, Milwaukee, WI 53296
| | - Katinka Hooyer
- Medical College of Wisconsin, Department of Family and Community Medicine, 8701 W Watertown Plank Rd., Wauwatosa, WI 53226
| | - Shannon M. Kehle-Forbes
- National Center for PTSD, Women’s Health Sciences Division, 150 S Huntington Ave, Boston, MA, 02130, USA
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota School of Medicine, 420 Delaware St. SE, Minneapolis MN 55455
| | - Jessica Hamblen
- National Center for PTSD, Executive Division, 215 N. Main St., White River Junction, VT 05009
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH, 03755, USA
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Cohen ZD, Barnes-Horowitz NM, Forbes CN, Craske MG. Measuring the active elements of cognitive-behavioral therapies. Behav Res Ther 2023; 167:104364. [PMID: 37429044 DOI: 10.1016/j.brat.2023.104364] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 06/09/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
Understanding how and for whom cognitive-behavioral therapies work is central to the development and improvement of mental health interventions. Suboptimal quantification of the active elements of cognitive-behavioral therapies has hampered progress in elucidating mechanisms of change. To advance process research on cognitive-behavioral therapies, we describe a theoretical measurement framework that focuses on the delivery, receipt, and application of the active elements of these interventions. We then provide recommendations for measuring the active elements of cognitive-behavioral therapies aligned with this framework. Finally, to support measurement harmonization and improve study comparability, we propose the development of a publicly available repository of assessment tools: the Active Elements of Cognitive-Behavioral Therapies Measurement Kit.
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Affiliation(s)
- Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States.
| | | | - Courtney N Forbes
- Department of Psychology, University of California, Los Angeles, United States
| | - Michelle G Craske
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States; Department of Psychology, University of California, Los Angeles, United States
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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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Bruijniks SJE, Frank U, Tuschen-Caffier B, Werthmann J, Renner F. Skill Improvement Through Learning in Therapy (SKILT): A Study Protocol for a Randomized Trial Testing the Direct Effects of Cognitive Behavioral Therapy Skill Acquisition and Role of Learning Capacity in Depression. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e8475. [PMID: 37065002 PMCID: PMC10103157 DOI: 10.32872/cpe.8475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 01/06/2023] [Indexed: 04/18/2023] Open
Abstract
Background To improve psychological treatments for major depressive disorder (MDD), a better understanding on how symptoms ameliorate during treatment is essential. In cognitive behavioral therapy (CBT), it is unclear whether procedures focused on the acquisition of CBT skills play a causal role in the improvement of CBT skills. In this randomized trial, we isolate a single CBT Skill Acquisition Procedure (CBTSAP) and test its direct effects on CBT skills and related therapy processes (i.e., change in (idiosyncratic) dysfunctional thinking and reward processing). We hypothesize that the CBTSAP causes improvements in CBT skills and related therapy processes compared to an active control condition. In addition, we hypothesize that individual differences in attentional bias and memory functioning (defined as learning capacity) moderate the effects of CBTSAP on outcomes and that using mental imagery as a cognitive support strategy to strengthen the effects of the CBTSAP will be most beneficial for patients with low learning capacity. Method 150 patients with MDD will be randomized to one of three conditions: 1. an active control condition, 2. CBTSAP, 2. CBTSAP plus mental imagery, all consisting of three sessions. Primary outcomes will be change in CBT skills, changes in (idiosyncratic) dysfunctional thoughts and behaviors, reward processing. Depressive symptoms are a secondary outcome. Measures of learning capacity will be conducted at baseline and tested as a potential moderator. Discussion Knowing whether and for whom the acquisition of CBT skills leads to change in therapy processes and a subsequent reduction of depressive symptoms will inform on how to personalize and optimize psychotherapy outcomes for depression. Trial registration The trial is registered at the German Clinical Trial Register (DKTR; registration number: DRKS00024116).
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Affiliation(s)
- Sanne J. E. Bruijniks
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Ulrike Frank
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Brunna Tuschen-Caffier
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Jessica Werthmann
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Fritz Renner
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
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10
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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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11
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Can integrating the Memory Support Intervention into cognitive therapy improve depression outcome? A randomized controlled trial. Behav Res Ther 2022; 157:104167. [DOI: 10.1016/j.brat.2022.104167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/12/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
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12
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Harvey AG. Treating sleep and circadian problems to promote mental health: perspectives on comorbidity, implementation science and behavior change. Sleep 2022; 45:zsac026. [PMID: 35079830 PMCID: PMC8996031 DOI: 10.1093/sleep/zsac026] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 01/14/2022] [Indexed: 01/27/2023] Open
Abstract
Insufficient sleep and mistimed sleep are prominent, yet under-appreciated and understudied, contributors to poor mental health and to mental disorders. The evidence that improving sleep and circadian functioning is an important pathway to mental health continues to mount. The goal of this paper is to highlight three major challenges ahead. Challenge 1 points to the possibility that comorbidity is the norm not the exception for the sleep and circadian disorders that are associated with mental disorders. Hence, the sleep and circadian problems experienced by people diagnosed with a mental disorder may not fit into the neat diagnostic categories of existing nosologies nor be adequately treated with single disorder approaches. The Sleep Health Framework and the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) are discussed as alternative approaches. Challenge 2 points to the large time lag between the development of a treatment and the availability of that treatment in routine clinical practice. This is a key reason for the emergence of implementation science, which is a flourishing, well-developed, and quickly moving field. There is an urgent need for more applications of implementation science within sleep and circadian science. Challenge 3 describes one of the greatest puzzles of our time-the need to unlock the fundamental elements of behavior change. There is potential to harness the science of behavior change to encourage widespread engagement in sleep health behavior and thereby reduce the staggering burden of sleep and circadian problems and the associated mental health problems.
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Affiliation(s)
- Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, USA
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13
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Mellor A, Kavaliotis E, Mascaro L, Drummond SP. Approaches to the assessment of adherence to CBT-I, predictors of adherence, and the association of adherence to outcomes: A systematic review. Sleep Med Rev 2022; 63:101620. [DOI: 10.1016/j.smrv.2022.101620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
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14
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Gumport NB, Harvey AG. Memory and learning for sleep and circadian treatment in serious mental illness treated in a community mental health setting. Behav Res Ther 2022; 149:104029. [PMID: 34995953 PMCID: PMC10883147 DOI: 10.1016/j.brat.2021.104029] [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: 11/04/2020] [Revised: 11/30/2021] [Accepted: 12/28/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Existing research has demonstrated that patient memory and learning of treatment contents are poor and poorer learning is associated with worse treatment outcome. Most prior studies have included individuals from only a single diagnostic group, offer limited data on possible contributors to poor memory and learning, and have included small samples recruited in university settings. This study sought to describe patient recall of treatment contents, describe patient learning of treatment contents, examine contributors to patient recall and learning of treatment contents, and examine the association of patient recall and learning of treatment contents with treatment outcome. METHODS Adults with serious mental illness and sleep and circadian dysfunction (N = 99) received the Transdiagnostic Intervention for Sleep and Circadian Dysfunction in a community mental health setting. Measures of recall, learning, age, years of education, symptom severity, and treatment outcome were collected at post-treatment and 6-month follow-up. RESULTS Recall and learning were poor, fewer years of education was associated with worse recall and learning, and recall and learning were not associated with treatment outcome. CONCLUSIONS The findings offer evidence that poor patient memory for, and learning of, treatment contents extends to community settings and are transdiagnostic concerns.
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Measuring Memory for Treatment Using Patient Conceptualizations of Clinical Vignettes: A Pilot Psychometric Study in the Context of Cognitive Therapy for Depression. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
Patient memory for psychological treatment contents is a promising transdiagnostic mechanism of change, but there is little consensus concerning its measurement. We conducted a pilot psychometric investigation of the Conceptualization Task, a novel measure of patient memory for treatment.
Methods
Data were from a trial comparing cognitive therapy-as-usual to cognitive therapy plus the Memory Support Intervention (MSI) for adults with depression (N = 171). For the Conceptualization Task, patients read clinical vignettes and provided written responses to assess three facets of conceptualization: identifying contributing factors to psychopathology, making intervention recommendations, and providing a rationale for recommendations. Higher scores were given to responses reflecting accurate memory for the theoretical model and change strategies used in treatment.
Results
The Conceptualization Task showed excellent inter-rater reliability and sensitivity to change during treatment, but only fair test–retest reliability and insufficient internal consistency. Findings supported discriminant validity with measures of education, IQ, and general memory functioning, but not convergent validity with existing measures of patient memory for treatment. Criterion validity analyses showed that some aspects of the Conceptualization Task were associated with therapist use of memory support strategies from the MSI and treatment outcome. However, findings were mixed, effect sizes were small, and some results did not remain statistically significant after correcting for multiple comparisons.
Conclusions
Further refinement and testing is needed before the Conceptualization Task may be used to assess the patient memory for treatment contents.
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16
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Gumport NB, Zieve GG, Dong L, Harvey AG. The Development and Validation of the Memory Support Treatment Provider Checklist. Behav Ther 2021; 52:932-944. [PMID: 34134832 PMCID: PMC8217732 DOI: 10.1016/j.beth.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/10/2020] [Accepted: 11/20/2020] [Indexed: 11/16/2022]
Abstract
Patient memory for the contents of treatment is staggeringly poor, and poor memory for treatment is associated with worse treatment outcome. Accordingly, the Memory Support Intervention was developed to improve patient memory for treatment as an adjunct to treatment as usual. As plans to disseminate the Memory Support Intervention are developed, it is important to have efficient, accurate methods of measuring fidelity to the intervention. However, the existing method of assessing fidelity to the Memory Support Intervention, the Memory Support Rating Scale (MSRS), is burdensome and requires trained independent-raters to spend multiple hours reviewing session recordings, which is not feasible in many routine mental health care settings. Hence, a provider-rated measure of fidelity to the MSI has been developed. The goal of this study is to examine the reliability and validity of scores on this measure-the Memory Support Treatment Provider Checklist. A sample of Memory Support Treatment Provider Checklists (N = 319) were completed by providers (N = 8) treating adults with depression (N = 84). Three metrics of the Memory Support Treatment Provider Checklist were evaluated: (a) the internal consistency and structural validity using confirmatory factor analysis based on prior research on the MSRS and the Memory Support Intervention, (b) construct validity, and (c) predictive validity. Results indicate that the Memory Support Treatment Provider Checklist yields reliable and valid scores of fidelity to the Memory Support Intervention. Overall, this checklist offers a viable, brief method of evaluating fidelity to the Memory Support Intervention.
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Affiliation(s)
| | | | - Lu Dong
- University of California, Berkeley,RAND Corporation
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17
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Smith S, Paparo J, Wootton BM. Understanding psychological treatment barriers, preferences and histories of individuals with clinically significant depressive symptoms in Australia: a preliminary study. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1892453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sinead Smith
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Josephine Paparo
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
- Discipline of Psychological Sciences, Australian College of Applied Psychology, Sydney, Australia
| | - Bethany M. Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
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18
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Agnew S, Vallières A, Hamilton A, McCrory S, Nikolic M, Kyle SD, Fleming L, Crawford MR. Adherence to Cognitive Behavior Therapy for Insomnia. Sleep Med Clin 2021; 16:155-202. [DOI: 10.1016/j.jsmc.2020.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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19
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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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20
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King BR, Boswell JF. Therapist and client attitudes toward client independent review of psychotherapy sessions. J Clin Psychol 2021; 77:1894-1904. [PMID: 33570192 DOI: 10.1002/jclp.23122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/12/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Little consideration has been given to the possibility that clients may find therapeutic value in reviewing (i.e., watching, listening, or reading transcripts of) their own therapy sessions independently. This study aimed to evaluate prevalence, interest, and preferences in this practice, beliefs regarding potential benefits and concerns, and overall attitudes. METHODS A diverse sample of clients (N = 275) as well as trainee (N = 85) and Master's/doctoral-level (N = 89) therapists of different therapeutic approaches completed forms online. Descriptive statistics, frequency counts, and one-way analysis of variance tests were used to analyze the data. RESULTS Relatively few clients and therapists have engaged in this practice, but clients report interest in doing so. All participant groups identified several advantages and concerns. Clients rated overall helpfulness and harm significantly higher than therapists. CONCLUSION Client independent review of sessions may be a promising transdiagnostic and transtheoretical treatment intervention. Future research is needed to evaluate its impact on treatment.
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Affiliation(s)
- Brittany R King
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
| | - James F Boswell
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
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21
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Depp C, Ehret B, Villa J, Perivoliotis D, Granholm E. A Brief Mobile-Augmented Suicide Prevention Intervention for People With Psychotic Disorders in Transition From Acute to Ongoing Care: Protocol for a Pilot Trial. JMIR Res Protoc 2021; 10:e14378. [PMID: 33555265 PMCID: PMC7899804 DOI: 10.2196/14378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/25/2019] [Accepted: 11/26/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific interventions for SMIs. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific cognitive behavioral intervention for SMIs that is augmented with mobile phone interactions. OBJECTIVE The primary aim of this pilot trial is to evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention. METHODS A 6-month pilot trial with 70 participants with a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, and current active suicidal ideation were randomized to START or START with mobile augmentation. START consists of 4 weekly sessions addressing early warning signs and triggers, symptoms influencing suicidal thinking, and social relationships. Recovery planning is followed by biweekly telephone coaching. START with mobile augmentation includes personalized automated cognitive behavioral therapy scripts that build from in-person content. Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of telephone coaching), and 24 weeks. In addition to providing point estimates of feasibility and acceptability, the primary outcome of the trial was the change in severity of suicidal ideation as measured with the Scale for Suicide Ideation (SSI) and secondary outcome included the rate of outpatient engagement. RESULTS The trial is ongoing. Feasibility and acceptability across conditions will be assessed using t tests or Mann-Whitney tests or chi-square tests. The reduction of SSI over time will be assessed using hierarchical linear models. CONCLUSIONS The design considerations and results of this trial may be informative for adapted suicide prevention in psychotic disorders in applied community settings. TRIAL REGISTRATION ClinicalTrials.gov NCT03198364; http://clinicaltrials.gov/ct2/show/NCT03198364. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14378.
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Affiliation(s)
- Colin Depp
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,VA San Diego Healthcare System, San Diego, CA, United States
| | - Blaire Ehret
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Jennifer Villa
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Dimitri Perivoliotis
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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22
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The Quality of Life in Bipolar Disorder (QoL.BD) questionnaire a decade on - A systematic review of the measurement of condition-specific aspects of quality of life in bipolar-disorder. J Affect Disord 2021; 278:33-45. [PMID: 32949871 DOI: 10.1016/j.jad.2020.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Condition-specific quality of life (QoL) instruments are more representative of the priorities of people with lived experience. As such, the development of the first and only bipolar disorder (BD) specific measurement instrument, the Quality of Life in Bipolar Disorder (QoL.BD) questionnaire, marked an important step forward for the literature. The present systematic review aims to characterise applications of the QoL.BD in the BD literature and review empirical findings obtained from studies using this measure. METHODS A systematic search identified 37 peer-reviewed publications which reported original empirical data using the QoL.BD in a BD population. No restrictions were placed on language/study type. RESULTS Adaptations to the QoL.BD displayed appropriate psychometric properties. Although clinical trials were typically underpowered, promising effect sizes for a number of treatment modalities were reported. QoL.BD scores were moderately correlated with depressive symptoms; a number of candidate predictors were identified. LIMITATIONS Due to resource limitations, the present review used one database (Google Scholar), and a single author reviewed articles for eligibility. On balance the risks of missing relevant studies were deemed minimal. CONCLUSION A sizeable, international body of evidence now exists regarding the measurement, presentation, and treatment of condition-specific aspects of QoL in BD. Key avenues for future research include large scale, randomized control clinical trials using the QoL.BD as a primary outcome, and granular exploration of potential correlates of QoL.BD domain scores. Finally, longer follow-up periods are required to inform understanding of the dynamic relationship between clinical variables and condition-specific aspects of QoL in BD.
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23
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Zhou FC, Yang Y, Wang YY, Rao WW, Zhang SF, Zeng LN, Zheng W, Ng CH, Ungvari GS, Zhang L, Xiang YT. Cognitive Behavioural Therapy for Insomnia Monotherapy in Patients with Medical or Psychiatric Comorbidities: a Meta-Analysis of Randomized Controlled Trials. Psychiatr Q 2020; 91:1209-1224. [PMID: 32860556 DOI: 10.1007/s11126-020-09820-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This is a meta-analysis of randomized controlled trials (RCTs) comparing cognitive behaviour therapy for insomnia (CBT-I) monotherapy with active control treatment for insomnia in patients with medical or psychiatric comorbidities. Both international (PubMed, EMBASE, PsycINFO, Cochrane Library) and Chinese (WanFang, and CNKI) databases were systematically searched. The random effects model was used. Thirteen RCTs comparing CBT-I (n = 441) and active controls (n = 412) groups were included. CBT-I group showed significant advantage over active controls at post-treatment assessment in terms of Insomnia Severity Index (ISI; SMD = -0.74), sleep onset latency (SMD = -0.36), wake after sleep onset (SMD = -0.21), sleep quality (SMD = 0.56), Pittsburgh sleep quality index total scores (PSQI; SMD = -0.76) and the total score of dysfunctional beliefs and attitudes about sleep scale (DBAS; SMD = -1.09). Subgroup analyses revealed significant improvement in sleep onset latency in patients with psychiatric disorders (SMD = -0.45), while significant reduction of number of wakeup after sleep onset was found in patients with medical conditions (SMD = -0.31). This meta-analysis found that CBT-I monotherapy had greater efficacy than other active control treatment for insomnia in patients with medical or psychiatric comorbidities.
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Affiliation(s)
- Fu-Chun Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Yang
- Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.,Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Yuan-Yuan Wang
- Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Wen-Wang Rao
- Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
| | - Shu-Fang Zhang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Liang-Nan Zeng
- Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.,Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- University of Notre Dame Australia / Graylands Hospital, Perth, Australia.,Division of Psychiatry, University of Western Australia Medical School, Perth, Australia
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.
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24
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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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25
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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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26
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De Vito AN, Ahmed M, Mohlman J. Cognitive Enhancement Strategies to Augment Cognitive-Behavioral Therapy for Anxiety and Related Disorders: Rationale and Recommendations for Use With Cognitively Healthy Older Adults. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Berg M, Rozental A, de Brun Mangs J, Näsman M, Strömberg K, Viberg L, Wallner E, Åhman H, Silfvernagel K, Zetterqvist M, Topooco N, Capusan A, Andersson G. The Role of Learning Support and Chat-Sessions in Guided Internet-Based Cognitive Behavioral Therapy for Adolescents With Anxiety: A Factorial Design Study. Front Psychiatry 2020; 11:503. [PMID: 32587533 PMCID: PMC7298729 DOI: 10.3389/fpsyt.2020.00503] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/18/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Increased awareness of anxiety in adolescents emphasises the need for effective interventions. Internet-based cognitive behavioural therapy (ICBT) could be a resource-effective and evidence-based treatment option, but little is known about how to optimize ICBT or which factors boost outcomes. Recently, the role of knowledge in psychotherapy has received increased focus. Further, chat-sessions are of interest when trying to optimize ICBT for youths. This study aimed to evaluate the role of learning support and chat-sessions during ICBT for adolescent anxiety, using a factorial design. METHOD A total of 120 adolescents were randomised to one of four treatment groups, in a 2x2 design with two factors: with or without learning support and/or chat-sessions. RESULTS Anxiety and depressive symptoms were reduced (Beck Anxiety Inventory- BAI; Cohen's d =0.72; Beck Depression Inventory- BDI; d =0.97). There was a main effect of learning support on BAI (d =0.38), and learning support increased knowledge gain (d =0.42). There were no main effects or interactions related to the chat-sessions. Treatment effects were maintained at 6-months, but the added effect of learning support had by then vanished. CONCLUSION ICBT can be an effective alternative when treating adolescents with anxiety. Learning support could be of importance to enhance short-term treatment effects, and should be investigated further.
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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 Institutet, Stockholm, Sweden.,Institute of Child Health, University College London, London, United Kingdom
| | - Josefine de Brun Mangs
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Maja Näsman
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Karin Strömberg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Linn Viberg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Erik Wallner
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Hanna Åhman
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Kristin Silfvernagel
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Maria Zetterqvist
- Department of Clinical and Experimental Medicine (IKE), Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linkoöping, Sweden
| | - Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Center for m2Health, Palo Alto, CA, United States
| | - Andrea Capusan
- Department of Clinical and Experimental Medicine (IKE), Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Institute of Child Health, University College London, London, United Kingdom
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28
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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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29
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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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Boettcher J, Magnusson K, Marklund A, Berglund E, Blomdahl R, Braun U, Delin L, Lundén C, Sjöblom K, Sommer D, von Weber K, Andersson G, Carlbring P. Adding a smartphone app to internet-based self-help for social anxiety: A randomized controlled trial. COMPUTERS IN HUMAN BEHAVIOR 2018. [DOI: 10.1016/j.chb.2018.04.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Deckersbach T, Peters AT, Shea C, Gosai A, Stange JP, Peckham AD, Ellard KK, Otto MW, Rauch SL, Dougherty DD, Nierenberg AA. Memory performance predicts response to psychotherapy for depression in bipolar disorder: A pilot randomized controlled trial with exploratory functional magnetic resonance imaging. J Affect Disord 2018; 229:342-350. [PMID: 29331692 PMCID: PMC5807220 DOI: 10.1016/j.jad.2017.12.041] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This pilot randomized controlled trial compared Cognitive Behavior Therapy (CBT) and Supportive Psychotherapy (SP) for the treatment of depression in bipolar I disorder. We also examined whether exploratory verbal memory, executive functioning, and neural correlates of verbal memory during functional magnetic resonance imaging (fMRI) predicted change in depression severity. METHODS Thirty-two adults (ages 18-65) with DSM-IV bipolar I disorder meeting current criteria for a major depressive episode were randomized to 18 weeks of CBT or SP. Symptom severity was assessed before, at the mid-point, and after the 18-week intervention. All participants completed a brief pre-treatment neuropsychological testing battery (including the California Verbal Learning Test-2nd Edition, Delis Kaplan Executive Functioning System [DKEFS] Trail-making Test, and DKEFS Sorting Test), and a sub-set of 17 participants provided usable fMRI data while completing a verbal learning paradigm that consisted of encoding word lists. RESULTS CBT and SP yielded comparable improvement in depressive symptoms from pre- to post-treatment. Better retention of learned information (CVLT-II long delay free recall vs. Trial 5) and recognition (CVLT-II hits) were associated with greater improvement in depression in both treatments. Increased activation in the left dorsolateral prefrontal cortex and right hippocampus during encoding was also related to depressive symptom improvement. LIMITATIONS Sample size precluded tests of clinical factors that may interact with cognitive/neural function to predict treatment outcome. CONCLUSION Neuropsychological assessment and fMRI offer additive information regarding who is most likely to benefit from psychotherapy for bipolar depression.
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Affiliation(s)
- Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Amy T Peters
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Conor Shea
- Department of Neuroscience, Boston University, Boston, MA, USA
| | - Aishwarya Gosai
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan P Stange
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Andrew D Peckham
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Michael W Otto
- Department of Psychology, Boston University, Boston, MA, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Patient learning of treatment contents in cognitive therapy. J Behav Ther Exp Psychiatry 2018; 58:51-59. [PMID: 28869825 PMCID: PMC5683909 DOI: 10.1016/j.jbtep.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/18/2017] [Accepted: 08/28/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Research has demonstrated that both memory and learning for treatment contents are poor, and that both are associated with worse treatment outcome. The Memory Support Intervention has been shown to improve memory for treatment, but it has not yet been established if this intervention can also improve learning of treatment contents. This study was designed to document the number of times participants exhibited each of the indices of learning, to examine the indices of learning and their relationship to recall of treatment points, and to investigate the association between the indices of learning and depression outcome. METHODS Adults diagnosed with major depressive disorder (N = 48) were randomly assigned to 14 sessions of cognitive therapy-as-usual (CT-as-usual) or cognitive therapy plus the Memory Support Intervention (CT + Memory Support). Measures of learning, memory, and depressive symptomatology were taken at mid-treatment, post-treatment, and at 6-month follow-up. RESULTS Relative to the CT-as-usual group, participants in the CT + Memory Support group reported more accurate thoughts and applications of treatment points at mid-treatment, post-treatment, and 6-month follow-up. Patient recall was significantly correlated with application and cognitive generalization. Thoughts and application at mid-treatment were associated with increased odds of treatment response at post-treatment. LIMITATIONS The learning measure for this study has not yet been psychometrically validated. The results are based on a small sample. CONCLUSIONS Learning during treatment is poor, but modifiable via the Memory Support Intervention. These results provide encouraging data that improving learning of treatment contents can reduce symptoms during and following treatment.
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Lipson‐Smith R, Hyatt A, Murray A, Butow P, Hack TF, Jefford M, Ozolins U, Hale S, Schofield P. Measuring recall of medical information in non-English-speaking people with cancer: A methodology. Health Expect 2018; 21:288-299. [PMID: 28940931 PMCID: PMC5750741 DOI: 10.1111/hex.12614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Many patients who require an interpreter have difficulty remembering information from their medical consultations. Memory aids such as consultation audio-recordings may be of benefit to these patients. However, there is no established means of measuring patients' memory of medical information. OBJECTIVES This study aimed to develop a method for eliciting and coding recall of medical information in non-English-speaking patients. DESIGN This method, called Patient-Interpreter-Clinician coding (PICcode), was developed in the context of a phase II trial conducted in two outpatient oncology clinics in Melbourne, Australia, and was refined iteratively through consultation with an expert panel and piloting. Between-coder differences in early versions of the coding system were resolved through discussion and consensus resulting in refinements to PICcode. RESULTS The final version of PICcode involved transcribing, translating and coding of audio-recorded consultations and semi-structured interviews (SSI). The SSIs were designed to elicit patients' free-recall of medical information. Every unit of medical information in the consultation was identified and categorized in a coding tree. SSIs were coded to identify the extent to which information was recalled from the consultation. DISCUSSION The iterative changes involved in developing PICcode assisted in clarifying precise details of the process and produced a widely applicable coding system. PICcode is the most comprehensively described method of determining the amount of information that patients who use an interpreter recall from their medical consultations. PICcode can be adapted for English-speaking patients and other healthcare populations.
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Affiliation(s)
- Ruby Lipson‐Smith
- Cancer Experiences ResearchPeter MacCallum Cancer CentreMelbourneVICAustralia
| | - Amelia Hyatt
- Cancer Experiences ResearchPeter MacCallum Cancer CentreMelbourneVICAustralia
| | - Alexandra Murray
- Cancer Experiences ResearchPeter MacCallum Cancer CentreMelbourneVICAustralia
| | - Phyllis Butow
- School of PsychologyUniversity of SydneySydneyNSWAustralia
- Centre of Medical Psychology and Evidence‐Based Decision‐MakingUniversity of SydneySydneyNSWAustralia
- Psycho‐Oncology Cooperative Research GroupUniversity of SydneySydneyNSWAustralia
| | - Thomas F. Hack
- College of NursingUniversity of ManitobaWinnipegMBCanada
- CancerCare Manitoba Research InstituteWinnipegMBCanada
- School of Health Sciences, University of Central Lancashire PrestonUK
| | - Michael Jefford
- Cancer Experiences ResearchPeter MacCallum Cancer CentreMelbourneVICAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia
| | - Uldis Ozolins
- School of Humanities and LanguagesUniversity of New South WalesSydneyNSWAustralia
| | - Sandra Hale
- School of Humanities and LanguagesUniversity of New South WalesSydneyNSWAustralia
| | - Penelope Schofield
- Cancer Experiences ResearchPeter MacCallum Cancer CentreMelbourneVICAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia
- Department of Psychological SciencesSwinburne University of TechnologyMelbourneVICAustralia
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Harvey AG, Dong L, Lee JY, Gumport NB, Hollon SD, Rabe-Hesketh S, Hein K, Haman K, McNamara ME, Weaver C, Martinez A, Notsu H, Zieve G, Armstrong CC. Can integrating the Memory Support Intervention into cognitive therapy improve depression outcome? Study protocol for a randomized controlled trial. Trials 2017; 18:539. [PMID: 29137655 PMCID: PMC5686897 DOI: 10.1186/s13063-017-2276-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/23/2017] [Indexed: 02/03/2023] Open
Abstract
Background The Memory Support Intervention was developed in response to evidence showing that: (1) patient memory for treatment is poor, (2) poor memory for treatment is associated with poorer adherence and poorer outcome, (3) the impact of memory impairment can be minimized by the use of memory support strategies and (4) improved memory for treatment improves outcome. The aim of this study protocol is to conduct a confirmatory efficacy trial to test whether the Memory Support Intervention improves illness course and functional outcomes. As a “platform” for the next step in investigating this approach, we focus on major depressive disorder (MDD) and cognitive therapy (CT). Method/design Adults with MDD (n = 178, including 20% for potential attrition) will be randomly allocated to CT + Memory Support or CT-as-usual and will be assessed at baseline, post treatment and at 6 and 12 months’ follow-up (6FU and 12FU). We will compare the effects of CT + Memory Support vs. CT-as-usual to determine if the new intervention improves the course of illness and reduces functional impairment (aim 1). We will determine if patient memory for treatment mediates the relationship between treatment condition and outcome (aim 2). We will evaluate if previously reported poor treatment response subgroups moderate target engagement (aim 3). Discussion The Memory Support Intervention has been developed to be “transdiagnostic” (relevant to a broad range of mental disorders) and “pantreatment” (relevant to a broad range of types of treatment). This study protocol describes a “next step” in the treatment development process by testing the Memory Support Intervention for major depressive disorder (MDD) and cognitive therapy (CT). If the results are promising, future directions will test the applicability to other kinds of interventions and disorders and in other settings. Trial registration ClinicalTrials.gov, ID: NCT01790919. Registered on 6 October 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2276-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allison G Harvey
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA.
| | - Lu Dong
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Jason Y Lee
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Nicole B Gumport
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | | | - Sophia Rabe-Hesketh
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Kerrie Hein
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | | | - Mary E McNamara
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Claire Weaver
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Armando Martinez
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Haruka Notsu
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Garret Zieve
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Courtney C Armstrong
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
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Dong L, Lee JY, Harvey AG. Memory support strategies and bundles: A pathway to improving cognitive therapy for depression? J Consult Clin Psychol 2017; 85:187-199. [PMID: 28221056 DOI: 10.1037/ccp0000167] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Therapist use of memory support (MS) alongside treatment-as-usual, with the goal of enhancing patient recall of treatment contents, has been of recent interest as a novel pathway to improve treatment outcome. The memory support intervention (MSI) involves treatment providers' using 8 specific MS strategies to promote patient memory for treatment. The present study examines to what extent therapist use of MS strategies and bundles improves patient recall of treatment contents and treatment outcome. METHOD The data were drawn from a pilot RCT reported elsewhere. Participants were 48 adults (mean age = 44.27 years, 29 females) with major depressive disorder (MDD), randomized to receive 14 sessions of either CT + Memory Support (n = 25) or CT-as-usual (n = 23). Therapist use of MS was coded using the Memory Support Rating Scale. Patient memory and treatment outcomes were assessed at baseline, midtreatment (patient recall only), posttreatment, and 6-month follow-up. RESULTS Participants in CT + Memory Support received significantly higher amount of MS relative to CT-as-usual. Although not reaching statistical significance, small-to-medium effects were observed between MS strategies and patient recall in the expected direction. Although MS variables were not significantly associated with changes in continuous depressive symptoms, MS was associated with better global functioning. MS also exhibited small to medium effects on treatment response and recurrence in the expected direction but not on remission, though these effects did not reach statistical significance. CONCLUSIONS These results provide initial empirical evidence supporting an active method for therapists to implement MS strategies. (PsycINFO Database Record
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Affiliation(s)
- Lu Dong
- Department of Psychology, University of California, Berkeley
| | - Jason Y Lee
- Department of Psychology, University of California, Berkeley
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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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Dong L, Lee JY, Harvey AG. Do improved patient recall and the provision of memory support enhance treatment adherence? J Behav Ther Exp Psychiatry 2017; 54:219-228. [PMID: 27614662 PMCID: PMC5558150 DOI: 10.1016/j.jbtep.2016.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient adherence to psychosocial treatment is an important but understudied topic. The aim of this study was to examine whether better patient recall of treatment contents and therapist use of memory support (MS) were associated with better treatment adherence. METHODS Data were drawn from a pilot randomized controlled trial. Participants were 48 individuals (mean age = 44.27 years, 29 females) with Major Depressive Disorder randomized to receive either Cognitive Therapy (CT) with an adjunctive Memory Support Intervention (CT + Memory Support) or CT-as-usual. Therapist and patient ratings of treatment adherence were collected during each treatment session. Patient recall was assessed at mid-treatment. Therapist use of MS was manually coded for a random selection of sessions. RESULTS Patient recall was significantly associated with better therapist and patient ratings of adherence. Therapist use of Application, a specific MS strategy, predicted higher therapist ratings of adherence. Attention Recruitment, another specific MS strategy, appeared to attenuate the positive impact of session number on patient ratings of adherence. Treatment groups, MS summary scores and other specific MS strategies were not significantly associated with adherence. LIMITATIONS The measure for treatment adherence is in the process of being formally validated. Results were based on small sample. CONCLUSIONS These results support the importance of patient recall in treatment adherence. Although collectively the effects of MS on treatment adherence were not significant, the results support the use of certain specific MS strategy (i.e., application) as a potential pathway to improve treatment adherence. Larger-scale studies are needed to further examine these constructs.
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Affiliation(s)
- Lu Dong
- University of California, Berkeley, United States
| | - Jason Y Lee
- University of California, Berkeley, United States
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Harvey AG. New Frontiers in Empirically Grounded Treatment Generation for Insomnia, Depression, and Bipolar Disorder: Translational Research With Transdiagnostic Implications. Int J Cogn Ther 2016. [DOI: 10.1521/ijct.2016.9.2.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Harvey AG, Lee J, Smith RL, Gumport NB, Hollon SD, Rabe-Hesketh S, Hein K, Dolsen EA, Haman KL, Kanady JC, Thompson MA, Abrons D. Improving outcome for mental disorders by enhancing memory for treatment. Behav Res Ther 2016; 81:35-46. [PMID: 27089159 PMCID: PMC5559714 DOI: 10.1016/j.brat.2016.03.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/11/2016] [Accepted: 03/28/2016] [Indexed: 11/21/2022]
Abstract
Patients exhibit poor memory for treatment. A novel Memory Support Intervention, derived from basic science in cognitive psychology and education, is tested with the goal of improving patient memory for treatment and treatment outcome. Adults with major depressive disorder (MDD) were randomized to 14 sessions of cognitive therapy (CT)+Memory Support (n = 25) or CT-as-usual (n = 23). Outcomes were assessed at baseline, post-treatment and 6 months later. Memory support was greater in CT+Memory Support compared to the CT-as-usual. Compared to CT-as-usual, small to medium effect sizes were observed for recall of treatment points at post-treatment. There was no difference between the treatment arms on depression severity (primary outcome). However, the odds of meeting criteria for 'response' and 'remission' were higher in CT+Memory Support compared with CT-as-usual. CT+Memory Support also showed an advantage on functional impairment. While some decline was observed, the advantage of CT+Memory Support was evident through 6-month follow-up. Patients with less than 16 years of education experience greater benefits from memory support than those with 16 or more years of education. Memory support can be manipulated, may improve patient memory for treatment and may be associated with an improved outcome.
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Affiliation(s)
| | - Jason Lee
- University of California, Berkeley, CA, USA
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Depp CA, Dev S, Eyler LT. Bipolar Depression and Cognitive Impairment: Shared Mechanisms and New Treatment Avenues. Psychiatr Clin North Am 2016; 39:95-109. [PMID: 26876321 PMCID: PMC4758200 DOI: 10.1016/j.psc.2015.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depression and cognitive impairment are pervasive and highly disabling aspects of bipolar disorder. Although cognitive impairment is partially independent from mood episodes, depressive symptoms may increase the risk of cognitive impairment in bipolar disorder through inflammatory processes as well as health risks such as obesity and sedentary behavior. Novel treatment avenues at the intersection of bipolar depression and cognitive impairment target inflammation directly or indirectly health behaviors such as diet, physical activity, and sleep hygiene.
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Affiliation(s)
- Colin A Depp
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research, Education, and Clinical Center, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
| | - Sheena Dev
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; SDSU-UCSD Joint Doctoral Program, Clinical Psychology, San Diego, CA, USA
| | - Lisa T Eyler
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research, Education, and Clinical Center, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
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Lee JY, Worrell FC, Harvey AG. The development and validation of the Memory Support Rating Scale. Psychol Assess 2015; 28:715-25. [PMID: 26389597 DOI: 10.1037/pas0000219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patient memory for treatment information is poor, and worse memory for treatment information is associated with poorer clinical outcomes. Memory support techniques have been harnessed to improve patient memory for treatment. However, a measure of memory support used by treatment providers during sessions has yet to be established. The present study reports on the development and psychometric properties of the Memory Support Rating Scale (MSRS)-an observer-rated scale designed to measure memory support. Adults with major depressive disorder (MDD; N = 42) were randomized to either cognitive therapy plus memory support (CT + MS; n = 22) or cognitive therapy as-usual (CT-as-usual; n = 20). At posttreatment, patients freely recalled treatment points via the patient recall task. Sessions (n = 171) were coded for memory support using the MSRS, 65% of which were also assessed for the quality of cognitive therapy via the Cognitive Therapy Rating Scale (CTRS). A unidimensional scale composed of 8 items was developed using exploratory factor analysis, though a larger sample is needed to further assess the factor structure of MSRS scores. High interrater and test-retest reliabilities of MSRS scores were observed across 7 MSRS coders. MSRS scores were higher in the CT + MS condition compared with CT-as-usual, demonstrating group differentiation ability. MSRS scores were positively associated with patient recall task scores but not associated with CTRS scores, demonstrating convergent and discriminant validity, respectively. Results indicate that the MSRS yields reliable and valid scores for measuring treatment providers' use of memory support while delivering cognitive therapy. (PsycINFO Database Record
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Affiliation(s)
- Jason Y Lee
- Department of Psychology, University of California, Berkeley
| | - Frank C Worrell
- Department of Psychology, University of California, Berkeley
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