Issues and findings in investigating predictors of psychotherapy outcome: Introduction to the special section

Deploying a robotic positive psychology coach to improve college students' psychological well-being

Despite the increase in awareness and support for mental health, college students' mental health is reported to decline every year in many countries. Several interactive technologies for mental health have been proposed and are aiming to make therapeutic service more accessible, but most of them only provide one-way passive contents for their users, such as psycho-education, health monitoring, and clinical assessment. We present a robotic coach that not only delivers interactive positive psychology interventions but also provides other useful skills to build rapport with college students. Results from our on-campus housing deployment feasibility study showed that the robotic intervention showed significant association with increases in students' psychological well-being, mood, and motivation to change. We further found that students' personality traits were associated with the intervention outcomes as well as their working alliance with the robot and their satisfaction with the interventions. Also, students' working alliance with the robot was shown to be associated with their pre-to-post change in motivation for better well-being. Analyses on students' behavioral cues showed that several verbal and nonverbal behaviors were associated with the change in self-reported intervention outcomes. The qualitative analyses on the post-study interview suggest that the robotic coach's companionship made a positive impression on students, but also revealed areas for improvement in the design of the robotic coach. Results from our feasibility study give insight into how learning users' traits and recognizing behavioral cues can help an AI agent provide personalized intervention experiences for better mental health outcomes.

Predictors of outcome after a time-limited psychosocial intervention for adolescent depression

Research on the predictors of outcome for early, community-based, and time-limited interventions targeted for clinical depression in adolescents is still scarce. We examined the role of demographic, psychosocial, and clinical variables as predictors of outcome in a trial conducted in Finnish school health and welfare services to identify factors associating to symptom reduction and remission after a brief depression treatment. A total of 55 12–16-year-olds with mild to moderate depression received six sessions of either interpersonal counseling for adolescents (IPC-A) or brief psychosocial support (BPS). Both interventions resulted in clinical improvement at end of treatment and 3- and 6-month follow-ups. Main outcome measures were self-rated BDI-21 and clinician-rated Adolescent Depression Rating Scale (ADRSc). Latent change score (LCS) models were used to identify predictors of change in depressive symptom scores and clinical remission at end of treatment and 3- and 6-month follow-ups over the combined brief intervention group. Symptom improvement was predicted by younger age and having a close relationship with parents. Both symptom improvement and clinical remission were predicted by male gender, not having comorbid anxiety disorder, and not having sleep difficulties. Our results add to knowledge on factors associating with good treatment outcome after a brief community intervention for adolescent depression. Brief depression interventions may be useful and feasible especially for treatment of mild and moderate depression among younger adolescents and boys, on the other hand clinicians may need to cautiously examine sleep problems and anxiety comorbidity as markers of the need for longer treatment.

Individualized Homeopathy: A Consideration of Its Relationship to Psychotherapy

OBJECTIVES

The benefit and potential mechanisms of action of homeopathy have long been debated. Almost entirely neglected has been the study of individualized homeopathy (IH) as a form of psychotherapy, which incorporates factors that are common to most therapies while using processes that are specific to IH.

METHODS

Recent research into the therapeutic components of IH is reviewed; similarities and differences between IH and other forms of psychotherapy are also described.

RESULTS

IH includes elements found in humanistic therapy and narrative medicine and additionally incorporates idiographic material in treatment selection. It is structured in a manner that takes maximum advantage of the components of the placebo effect, which could further expand its effectiveness beyond those conditions thought usually amenable to psychotherapy.

CONCLUSIONS

It is possible that IH entails specific psychotherapeutic processes in addition to possible therapeutic action of the homeopathic remedy, but the relative contributions of each remain to be determined. Suggestions are given for future research.

Dimensions of the operationalized psychodynamic diagnosis system that predict long-term outcome after inpatient psychotherapy

BACKGROUND/AIMS

To determine whether the Operationalized Psychodynamic Diagnosis (OPD) system can be useful in predicting patient outcome in the long term.

METHODS

OPD was assessed by the therapists prior to and after inpatient treatment. Patients completed psychometric scales at the start and completion of psychosomatic-psychotherapeutic inpatient treatment and at the follow-up. Outcome was defined by the general factor emerging from a principal component analysis of the Brief Symptom Inventory, Hospital Anxiety and Depression Scale and Inventory of Interpersonal Problems at katamnesis, representing individual differences in general distress.

RESULTS

Several dimensions of the OPD system proved to be predictors of general distress at the follow-up in 253 former inpatients. Negative predictors of long-term outcome were the high internal impediments to change, namely high secondary gains from illness and also less integrated structural abilities. Positive OPD predictors of long-term outcome were the treatment success achieved at the end of inpatient psychotherapy in changing the illness concept towards a psychological understanding of symptoms, lower levels of complaints and a higher functional level. Also the achieved level of awareness for the individual maladaptive behavioral pattern is predictive of a favorable long-term outcome.

CONCLUSIONS

The results provide evidence for the clinical relevance and the predictive value of OPD. © 2014 S. Karger AG, Basel.

Baseline training in cognitive and psychodynamic psychotherapy during a psychologist training program. Exploring client outcomes in therapies of one or two semesters

This effectiveness study explored the outcomes of 187 clients seen by 187 students undergoing baseline training in psychotherapy. Clients reduced their symptoms (SCL-90) and increased their positive self-image (SASB introject) during the therapy. Multiple regression analyses showed no differences between the cognitive and the psychodynamic training approaches and no differences between one and two semesters duration of the therapies. However, 2-3% of variance in end states was accounted for by the interaction between the variables, indicating a moderating effect of duration in the two approaches. Outcomes for clients in the cognitive training approach were significantly better with two semesters than with one semester, while there was no such difference in the psychodynamic approach. Consequences for baseline training are discussed.

Patient sex as moderator of effects of transference interpretation in a randomized controlled study of dynamic psychotherapy

OBJECTIVE

To examine whether men and women respond differentially to brief dynamic psychotherapy, with or without transference interpretations.

METHOD

Data from the First Experimental Study of Transference Interpretation were used. Patients (n = 100) were randomized to receive 2 different dynamic psychotherapies during 1 year, with either a moderate level of transference interpretations or no transference interpretations. We used the following outcome measures: the Psychodynamic Functioning Scales, Inventory of Interpersonal Problems-Circumplex Version, Global Assessment of Functioning (GAF), and total mean score of Symptom Checklist-90-Revised (Global Severity Index [GSI]). Change was assessed using linear-mixed models.

RESULTS

On average, men and women responded equally across treatments. The moderator analyses, using the 2 secondary outcome measures, GAF and GSI, demonstrated that women responded better to therapy with transference interpretations, compared with men, whereas men responded better to therapy without transference interpretations, compared with women. When the moderator sex was combined with the moderator quality of object relations (QOR), a strong effect emerged: men with high QOR showed a large negative effect of transference interpretations, and women with low QOR showed a large positive effect.

CONCLUSIONS

In terms of symptom change, women responded better to therapy with transference interpretations, while men responded better to therapy without transference interpretations. Patient sex showed moderator effects over and above the moderator effects of QOR.

CLINICAL TRIAL REGISTRATION NUMBER

NCT00423462.

Considerations in treatment integrity: implications and recommendations for PTSD research

In this article, the authors address the rationale for and uses of treatment integrity measurement in psychotherapy research, focusing on therapists' adherence and competence in trauma and posttraumatic stress disorder treatment research. The following issues are examined: (a) distinctions between adherence monitoring, performed contemporaneously with ongoing study treatments, and adherence evaluation, and the implications for outcomes analysis; (b) simultaneous measurement of adherence and competence; (c) selection of sessions for adherence/competence assessment and the need for concurrent outcome measurement, and (d) the association between therapist adherence, competence, alliance and treatment outcome. Recommendations regarding common problems in the implementation of adherence and competence measurement are made throughout. The article concludes with a summary of steps and considerations in decision-making with regard to treatment integrity.

Predictors of treatment duration and retention in a study of long-term dynamic psychotherapy: childhood adversity, adult personality, and diagnosis

Systematic knowledge about patient characteristics that predict the duration of long-term psychotherapy is largely absent. We examined predictors of attrition, retention, and duration of long-term dynamic psychotherapy to delineate the naturalistic history of psychotherapy, specifically focusing on childhood emotional neglect and abuse, adult diagnosis, personality, and functioning as predictors. Fifty-three adults with depressive, anxiety, and/or personality disorders (PDs) were offered at least 3 years of long-term dynamic psychotherapy. The median duration of therapy for the study group was 110 sessions (95% confidence interval [CI] 52-141). Nondynamic characteristics (including demographics; most Axis I diagnoses; depression, anxiety, and distress scores; social and global functioning; and the five personality factors) did not predict number of sessions. Dysthymic disorder, presence of any PD (particularly dependent PD [DPD]), emotional neglect in childhood, and higher adaptive defense style scores predicted a greater number of sessions, while obsessive-compulsive PD (OCPD) predicted fewer sessions. Emotional neglect, DPD, higher adaptive defenses, and OCPD were each unique predictors of duration. A session frequency less than 0.7 sessions per week (36 sessions per year) was associated with a three-fold higher risk for intrinsic attrition (relative risk = 3.04, 95% CI 1.10-8.44). Childhood emotional neglect as well as adult dependency may predispose patients to remain in therapy for longer durations, while some adaptive defenses may allow patients to contain the distressing affects that might otherwise lead to early termination. It remains to be seen whether longer durations of treatments are associated with respectively greater improvement, other things being equal, and whether these findings generalize to other types of treatment.