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Meddings J, Harries AD, Michelet F, Nall-Evans S, Pender F, Jaydeokar S. Short Research Article: Do demographic, socioeconomic and clinical characteristics influence the number of psychological intervention sessions attended by young people in need of mental health care? Child Adolesc Ment Health 2022. [PMID: 36545782 DOI: 10.1111/camh.12611] [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] [Accepted: 10/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND METHOD A cohort study using secondary data assessed associations between baseline characteristics and psychological sessions attended in young persons discharged from a Children and Young People's Mental Health Service in 2019. RESULTS There were 584 persons who attended a median of seven sessions. On multivariable regression analysis, males attended fewer sessions than females, young people from more affluent communities attended more sessions than those from poorer communities and those presenting with eating disorders and self-harm in particular attended more sessions than those with anxiety. CONCLUSIONS Addressing why these associations occur may improve mental health care in young persons.
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Affiliation(s)
- John Meddings
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Faculty of Infectious Diseases and Tropical Medicine, London School of Hygiene and Tropical Medicine, London, UK
| | - Felix Michelet
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Fiona Pender
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Sujeet Jaydeokar
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK.,Centre for Autism Neurodevelopmental Disorders and Intellectual Disability (CANDDID), UK.,University of Chester Medical School, Chester, UK
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2
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3
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Arora S, Bhatia S. Gender differences in factors that facilitate successful therapeutic progress and outcome: A pilot study. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Saachi Arora
- University of Delhi Department of Psychology Delhi India
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4
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Fonctionnements et dysfonctionnements des psychothérapies : synthèse de la littérature et présentation de deux méthodologies associées aux meilleurs résultats. PRAT PSYCHOL 2021. [DOI: 10.1016/j.prps.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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5
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Gergov V, Lindberg N, Lahti J, Lipsanen J, Marttunen M. Effectiveness and Predictors of Outcome for Psychotherapeutic Interventions in Clinical Settings Among Adolescents. Front Psychol 2021; 12:628977. [PMID: 33664698 PMCID: PMC7921706 DOI: 10.3389/fpsyg.2021.628977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this study was to investigate the effectiveness of psychotherapeutic interventions for clinically referred adolescents, as well as to examine whether sociodemographic, clinical, or treatment-related variables and patients’ role expectations predict treatment outcome or are possible predictors of treatment dropout. Method The study comprised 58 adolescents (mean age 14.2, 65.5% female) suffering from diverse psychiatric disorders referred to psychotherapeutic interventions conducted in outpatient care. The outcome measures, The Beck Depression Inventory, and the Clinical Outcomes in Routine Evaluation – Outcome Measure were filled in at baseline and at 3-, 6-, and 12-month follow-ups. Possible predictors were assessed at baseline. Results The results indicate that the mean level of symptoms and psychological distress decreased during the treatment, most reduction occurring in the first 6 months. The frequency of treatment sessions was the strongest predictor of good outcome. Adolescents with a higher level of externalizing problems or lower level of expectations for their own active role in treatment seem to have a higher risk of dropping out. Conclusion Offering intensive treatment for a shorter period might be the most efficient way to gain symptom reduction and decrease psychological distress in psychotherapeutic interventions with adolescents. Being aware of externalizing behavior and increasing the adolescents’ own agency during the assessment could strengthen commitment and result in the adolescent benefiting more from treatment.
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Affiliation(s)
- Vera Gergov
- Department of Adolescent Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Nina Lindberg
- Department of Forensic Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jari Lahti
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Lipsanen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mauri Marttunen
- Department of Adolescent Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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6
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Bo S, Vilmar JW, Jensen SL, Jørgensen MS, Kongerslev M, Lind M, Fonagy P. What works for adolescents with borderline personality disorder: towards a developmentally informed understanding and structured treatment model. Curr Opin Psychol 2020; 37:7-12. [PMID: 32652486 DOI: 10.1016/j.copsyc.2020.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 10/24/2022]
Abstract
The efficacy of treatment of borderline personality disorder in adolescents is an underresearched area. Although increasing research in borderline personality disorder in adolescents has emerged over the last decade there is a paucity of knowledge about how treatment is adequately designed for this group of patients. As a consequence, it is currently difficult to provide evidence-based guidelines and firm recommendations for how to design and implement borderline treatment in adolescence. In this selective review we summarize the most important research findings concerning treatment for adolescents with borderline personality disorder, including a recent mentalisation-based group treatment program. We highlight pivotal developmental obstacles for psychotherapy in adolescence and integrate these into a framework for the understanding and designing of effective treatment of borderline in adolescence.
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Affiliation(s)
- Sune Bo
- Psychiatric Research Unit, Region Zealand, Denmark; Child and Adolescents Psychiatry, Region Zealand, Denmark.
| | | | | | | | - Mickey Kongerslev
- Psychiatric Research Unit, Region Zealand, Denmark; Department of Psychology, University of Southern Denmark, Denmark
| | - Majse Lind
- Department of Psychology, University of Florida, United States; Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, England, United Kingdom
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7
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Elkins DN. Common Factors: What Are They and What Do They Mean for Humanistic Psychology? JOURNAL OF HUMANISTIC PSYCHOLOGY 2019. [DOI: 10.1177/0022167819858533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although common factors have been widely discussed in the clinical literature, the two questions addressed in this article remain relevant: (a) What are the common factors? (b) What do they mean for humanistic psychology? The first question is important because there is no “definitive list” of common factors, and lists presented in the literature often differ dramatically. In response to this question, the article suggests that an evidence-based list of nine common factors by Wampold provides a useful and credible list. The second question is also important, particularly to humanistic psychologists. Among other answers, the article shows that research findings on common factors provide scientific support for humanistic psychology’s emphasis on the importance of the human and relational factors in psychotherapy.
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8
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Weisz JR, Kuppens S, Ng MY, Vaughn-Coaxum RA, Ugueto AM, Eckshtain D, Corteselli KA. Are Psychotherapies for Young People Growing Stronger? Tracking Trends Over Time for Youth Anxiety, Depression, Attention-Deficit/Hyperactivity Disorder, and Conduct Problems. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2019; 14:216-237. [PMID: 30571478 DOI: 10.1177/1745691618805436] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
With the development of empirically supported treatments over the decades, have youth psychotherapies grown stronger? To investigate, we examined changes over time in treatment effects for four frequently treated youth mental-health problems: anxiety, depression, attention-deficit hyperactivity disorder (ADHD), and conduct disorders. We used PubMed and PsycINFO to search for randomized controlled trials (RCTs) that were published between January 1960 and May 2017 involving youths between the ages of 4 and 18 years. We also searched reviews and meta-analyses of youth psychotherapy research, followed reference trails in the reports we identified, and obtained additional studies identified by therapy researchers whom we contacted. We identified 453 RCTs (31,933 participants) spanning 53 years (1963-2016). Effect sizes for the problem-relevant outcome measures were synthesized via multilevel meta-analysis. We tracked temporal trends for each problem domain and then examined multiple study characteristics that might moderate those trends. Mean effect size increased nonsignificantly for anxiety, decreased nonsignificantly for ADHD, and decreased significantly for depression and conduct problems. Moderator analyses involving multiple study subgroups showed only a few exceptions to these surprising patterns. The findings suggest that new approaches to treatment design and intervention science may be needed, especially for depression and conduct problems. We suggest intensifying the search for mechanisms of change, making treatments more transdiagnostic and personalizable, embedding treatments within youth ecosystems, adapting treatments to the social and technological changes that alter youth dysfunction and treatment needs, and resisting old habits that can make treatments unduly skeuomorphic.
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Affiliation(s)
| | - Sofie Kuppens
- 2 Department of Public Health and Primary Care, KU Leuven
- 3 Karel de Grote University College
| | - Mei Yi Ng
- 4 Department of Psychology, Florida International University
| | | | - Ana M Ugueto
- 5 Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Dikla Eckshtain
- 6 Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School
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9
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Yoder WR, Karyotaki E, Cristea IA, van Duin D, Cuijpers P. Researcher allegiance in research on psychosocial interventions: meta-research study protocol and pilot study. BMJ Open 2019; 9:e024622. [PMID: 30782912 PMCID: PMC6377509 DOI: 10.1136/bmjopen-2018-024622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION One potential source of bias in randomised clinical trials of psychological interventions is researcher allegiance (RA). The operationalisation of RA differs strongly across studies, and there is not a generally accepted method of operationalising or measuring it. Furthermore, it remains unclear as to how RA affects the outcomes of trials and if it results in better outcomes for a preferred intervention. The aim of this project is to develop and validate a scale that accurately identifies RA, contribute to the understanding of the impact that RA has in a research setting and to make recommendations for addressing RA in practice. METHODS AND ANALYSIS A scale will first be developed and validated to measure RA in psychotherapy trials. The scale will be validated by surveying authors of psychotherapy trials to assess their opinions, beliefs and preferences of psychotherapy interventions. Furthermore, the scale will be validated for use outside the field of psychotherapy. The validated checklist will then be used to examine two potential mechanisms of how RA may affect outcomes of interventions: publication bias (by assessing grants) and risk of bias (RoB). Finally, recommendations will be developed, and a feasibility study will be conducted at a national mental health agency in The Netherlands. Main analyses comprise inter-rater reliability of checklist items, correlations to examine the relationship between checklist items and author survey (convergent validity) as well as checklist items and trial outcomes and multivariate meta-regression techniques to assess potential mechanisms of how allegiance affects trial outcomes (publication bias and RoB). ETHICS AND DISSEMINATION This study has been reviewed and approved by the Scientific and Ethical Review Board (VCWE) at the Vrije Universiteit Amsterdam. Study result and advancements will also be published on the Open Science Framework. Furthermore, main findings will be disseminated through articles in international peer-reviewed open access journals. Results and recommendations will be communicated to the Cochrane Collaboration, the Campbell Collaboration and other funding agencies.
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Affiliation(s)
- Whitney Rose Yoder
- Department of Clinical, Neuro and Developmental Psychology Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ioana-Alina Cristea
- Department of Clinical, Neuro and Developmental Psychology Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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10
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Locher C, Gaab J, Blease C. When a Placebo Is Not a Placebo: Problems and Solutions to the Gold Standard in Psychotherapy Research. Front Psychol 2018; 9:2317. [PMID: 30542310 PMCID: PMC6277873 DOI: 10.3389/fpsyg.2018.02317] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/05/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Charlotte Blease
- Program in Placebo Studies, General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard, MA, United States.,School of Psychology, University College Dublin, Dublin, Ireland
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11
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Short D. Conversational Hypnosis: Conceptual and Technical Differences Relative to Traditional Hypnosis. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2018; 61:125-139. [PMID: 30260303 DOI: 10.1080/00029157.2018.1441802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This article provides an overview of conversational hypnosis (CH) as distinct from traditional forms. The article includes a history of Ericksonian hypnosis followed by a conceptual model and operational definitions for CH. The analysis is built on three levels of comparison and contrast. Three concepts commonly used in the general hypnosis literature-focusing, engaging, and inciting-structure a comprehensive definition of CH. The article concludes with recommendations for future research.
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Affiliation(s)
- Dan Short
- Southwest College of Naturopathic Medicine and Health Sciences, Tempe, Arizona, USA
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12
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Abstract
Attention-deficit hyperactivity disorder (ADHD) is a fact of culture rather than a fact of nature. For a diagnosis like ADHD to be scientifically useful you need to show that the concept leads to advancement of knowledge around causes. For it to be clinically useful, you need to show that use of the concept leads to improved clinical outcomes. As neither can be convincingly demonstrated, ADHD is unlikely to be either scientifically or clinically useful and the concept is well past its use-by date.
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13
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Attention-deficit hyperactivity disorder (ADHD): progress and controversy in diagnosis and treatment. Ir J Psychol Med 2018. [DOI: 10.1017/ipm.2018.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Knowledge about attention-deficit hyperactivity disorder (ADHD) is rapidly accumulating. Recent advances in diagnosis, genetics, neuroimaging, drug and non-drug treatments are considered, and the results are related to the critical attack on the ADHD diagnosis, which argues it a medicalising social construct, unhelpfully sustaining power relationships. The advances reviewed suggest that, while this attack can be conclusively dismissed as wrong and misleading, the phenomenological definition of ADHD is no longer sufficient for construct validity, though continues to be valuable as a guide for clinicians. The humanising and individualising concerns underlying the attack on the diagnosis could usefully be redirected to improving effective measurement of patient outcomes.
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14
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Timimi S. The diagnosis is correct, but National Institute of Health and Care Excellence guidelines are part of the problem not the solution. J Health Psychol 2018; 23:1148-1152. [PMID: 29600731 DOI: 10.1177/1359105318766139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mike Scott's study provides data demonstrating that the national Improving Access to Psychological Therapies project is not leading to improved outcomes or value for money. I present further data from both the adult and children and young people's versions of Improving Access to Psychological Therapies that lends supports to this conclusion. However, while Scott argues in favour of better compliance with National Institute of Health and Care Excellence guidelines and greater model expertise, I argue that it is this 'technical' focus that is part of the problem not the solution.
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Affiliation(s)
- Sami Timimi
- 1 Lincolnshire Partnership NHS Foundation Trust, UK.,2 Health Education England, UK.,3 University of Lincoln, UK
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15
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Gaab J, Locher C, Blease C. Placebo and Psychotherapy: Differences, Similarities, and Implications. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 138:241-255. [PMID: 29681328 DOI: 10.1016/bs.irn.2018.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The placebo and psychotherapy are both effective psychological interventions. Next to being characterized by their own and specific controversies and debates, there is a persistent-and least for psychotherapy-looming notion that these two interventions share more than just the first letter. Based on Grünbaum's influential conceptualization of placebo, this chapter critically reviews both the time-honored claim that psychotherapy is a placebo as well as the argument that the placebo concept does not translate to psychotherapy. We conclude that there is an unwanted proximity between these two interventions and that empirical attempts to separate the "wheat from the chaff" in psychotherapy research face several distinctive challenges and thus are often methodologically comprised by the integrity of the placebo. However, drawing on recent, innovative research, we conclude that psychotherapy can be saved, i.e., shown to be distinct from the placebo, by employing study designs derived from the placebo research. We conclude that the placebo concept has profound implications for psychotherapy, psychotherapy research, and last but not least its ethical practice.
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Affiliation(s)
- Jens Gaab
- Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland.
| | - Cosima Locher
- Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | - Charlotte Blease
- School of Psychology, University College Dublin, Dublin, Ireland; Program in Placebo Studies and the Therapeutic Encounter, Harvard Medical School, Boston, MA, United States
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16
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Timimi S. Non-diagnostic based approaches to helping children who could be labelled ADHD and their families. Int J Qual Stud Health Well-being 2017; 12:1298270. [PMID: 28532324 PMCID: PMC5510228 DOI: 10.1080/17482631.2017.1298270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 12/05/2022] Open
Abstract
Mental health services are not always good for you. There are some troubling facts to confront such as the increase in the use of diagnostic based approaches and psychotropic medications for children and young people being associated with poorer rather than better outcomes. In this article I will outline some of the evidence around outcome as a result of treatment for young people diagnosed with attention deficit hyperactivity disorder (ADHD) and for those who are prescribed long-term stimulants. I will then discuss clinical approaches that move beyond a focus on symptom management that diagnostic paradigms encourage. This includes clinical models that take account of the diversity of contextual and relational issues that young patients present with and the possibility afforded of engaging in more positive and hopeful therapeutic approaches such as the Relational Awareness Programme (RAP).
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Affiliation(s)
- Sami Timimi
- Faculty of Health and Social Sciences, University of Lincoln, Lincoln, UK
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17
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Leichsenring F, Abbass A, Hilsenroth MJ, Leweke F, Luyten P, Keefe JR, Midgley N, Rabung S, Salzer S, Steinert C. Biases in research: risk factors for non-replicability in psychotherapy and pharmacotherapy research. Psychol Med 2017; 47:1000-1011. [PMID: 27955715 DOI: 10.1017/s003329171600324x] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Replicability of findings is an essential prerequisite of research. For both basic and clinical research, however, low replicability of findings has recently been reported. Replicability may be affected by research biases not sufficiently controlled for by the existing research standards. Several biases such as researcher allegiance or selective reporting are well-known for affecting results. For psychotherapy and pharmacotherapy research, specific additional biases may affect outcome (e.g. therapist allegiance, therapist effects or impairments in treatment implementation). For meta-analyses further specific biases are relevant. In psychotherapy and pharmacotherapy research these biases have not yet been systematically discussed in the context of replicability. Using a list of 13 biases as a starting point, we discuss each bias's impact on replicability. We illustrate each bias by selective findings of recent research, showing that (1) several biases are not yet sufficiently controlled for by the presently applied research standards, (2) these biases have a pernicious effect on replicability of findings. For the sake of research credibility, it is critical to avoid these biases in future research. To control for biases and to improve replicability, we propose to systematically implement several measures in psychotherapy and pharmacotherapy research, such as adversarial collaboration (inviting academic rivals to collaborate), reviewing study design prior to knowing the results, triple-blind data analysis (including subjects, investigators and data managers/statisticians), data analysis by other research teams (crowdsourcing), and, last not least, updating reporting standards such as CONSORT or the Template for Intervention Description and Replication (TIDieR).
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Affiliation(s)
- F Leichsenring
- Department of Psychosomatics and Psychotherapy,Justus-Liebig-University Giessen,Giessen,Germany
| | - A Abbass
- Department of Psychiatry,Dalhousie University,Centre for Emotions and Health,Halifax,NS,Canada
| | - M J Hilsenroth
- The Derner Institute of Advanced Psychological Studies,Adelphi University,NY,USA
| | - F Leweke
- Department of Psychosomatics and Psychotherapy,Justus-Liebig-University Giessen,Giessen,Germany
| | - P Luyten
- Faculty of Psychology and Educational Sciences,University of Leuven,Klinische Psychologie (OE),Leuven,Belgium
| | - J R Keefe
- Department of Psychology,University of Pennsylvania,Philadelphia,PA,USA
| | | | - S Rabung
- Department of Psychology,Alpen-Adria-Universität Klagenfurt,Universitätsstr,Klagenfurt,Austria
| | - S Salzer
- Clinic of Psychosomatic Medicine and Psychotherapy,Georg-August-Universität Goettingen,Göttingen,Germany
| | - C Steinert
- Department of Psychosomatics and Psychotherapy,Justus-Liebig-University Giessen,Giessen,Germany
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18
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M Golding J. Evidence-based child and adolescent psychotherapy: It's not what you think. J Paediatr Child Health 2016; 52:919-922. [PMID: 27586158 DOI: 10.1111/jpc.13272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 03/14/2016] [Accepted: 05/08/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Jacqueline M Golding
- Institute for Health and Aging, University of California, San Francisco, California, United States of America.
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19
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Abstract
AIMS Suppose you are the developer of a new therapy for a mental health problem or you have several years of experience working with such a therapy, and you would like to prove that it is effective. Randomised trials have become the gold standard to prove that interventions are effective, and they are used by treatment guidelines and policy makers to decide whether or not to adopt, implement or fund a therapy. METHODS You would want to do such a randomised trial to get your therapy disseminated, but in reality your clinical experience already showed you that the therapy works. How could you do a trial in order to optimise the chance of finding a positive effect? RESULTS Methods that can help include a strong allegiance towards the therapy, anything that increases expectations and hope in participants, making use of the weak spots of randomised trials (risk of bias), small sample sizes and waiting list control groups (but not comparisons with existing interventions). And if all that fails one can always not publish the outcomes and wait for positive trials. CONCLUSIONS Several methods are available to help you show that your therapy is effective, even when it is not.
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20
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Sharp C, Fowler JC, Salas R, Nielsen D, Allen J, Oldham J, Kosten T, Mathew S, Madan A, Frueh BC, Fonagy P. Operationalizing NIMH Research Domain Criteria (RDoC) in naturalistic clinical settings. Bull Menninger Clin 2016; 80:187-212. [DOI: 10.1521/bumc.2016.80.3.187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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21
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Tran US, Gregor B. The relative efficacy of bona fide psychotherapies for post-traumatic stress disorder: a meta-analytical evaluation of randomized controlled trials. BMC Psychiatry 2016; 16:266. [PMID: 27460057 PMCID: PMC4962479 DOI: 10.1186/s12888-016-0979-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/15/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In the treatment of PTSD, meta-analyses suggest comparable efficacy of cognitive behavioural therapies and various trauma focused treatments, but results for other treatments are inconsistent. One meta-analysis found no differences for bona fide therapies, but was critizised for overgeneralization and a biased study sample and relied on an omnibus test of overall effect size heterogeneity that is not widely used. METHODS We present an updated meta-analysis on bona fide psychotherapies for PTSD, contrasting an improved application of the omnibus test of overall effect size heterogeneity with conventional random-effects meta-analyses of specified treatment types against all others. Twenty-two studies were eligible, reporting 24 head-to-head comparisons in randomized controlled trials of 1694 patients. RESULTS Head-to-head comparison between trauma focused and non-trauma focused treatments revealed a small relative advantage for trauma focused treatments at post-treatment (Hedges' g = 0.14) and at two follow-ups (g = 0.17, g = 0.23) regarding PTSD symptom severity. Controlling and adjusting for influential studies and publication bias, prolonged exposure and exposure therapies (g = 0.19) were slightly more efficacious than other therapies regarding PTSD symptom severity at post-treatment; prolonged exposure had also higher recovery rates (RR = 1.26). Present-centered therapies were slightly less efficacious regarding symptom severity at post-treatment (g = -0.20) and at follow-up (g = -0.17), but equally efficacious as available comparison treatments with regards to secondary outcomes. The improved omnibus test confirmed overall effect size heterogeneity. CONCLUSIONS Trauma focused treatments, prolonged exposure and exposure therapies were slightly more efficacious than other therapies in the treatment of PTSD. However, treatment differences were at most small and far below proposed thresholds of clinically meaningful differences. Previous null findings may have stemmed from not clearly differentiating primary and secondary outcomes, but also from a specific use of the omnibus test of overall effect size heterogeneity that appears to be prone to error. However, more high-quality studies using ITT analyses are still needed to draw firm conclusions. Moreover, the PTSD treatment field may need to move beyond a focus primarily on efficacy so as to address other important issues such as public health issues and the requirements of highly vulnerable populations.
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Affiliation(s)
- Ulrich S. Tran
- Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Liebiggasse 5, A-1010 Vienna, Austria
| | - Bettina Gregor
- Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Liebiggasse 5, A-1010 Vienna, Austria
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22
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Cuijpers P. Are all psychotherapies equally effective in the treatment of adult depression? The lack of statistical power of comparative outcome studies. EVIDENCE-BASED MENTAL HEALTH 2016; 19:39-42. [PMID: 26984413 PMCID: PMC10699414 DOI: 10.1136/eb-2016-102341] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/26/2016] [Indexed: 11/03/2022]
Abstract
More than 100 comparative outcome trials, directly comparing 2 or more psychotherapies for adult depression, have been published. We first examined whether these comparative trials had sufficient statistical power to detect clinically relevant differences between therapies of d=0.24. In order to detect such an effect size, power calculations showed that a trial would need to include 548 patients. We selected 3 recent meta-analyses of psychotherapies for adult depression (cognitive behaviour therapy (CBT), interpersonal psychotherapy and non-directive counselling) and examined the number of patients included in the trials directly comparing other psychotherapies. The largest trial comparing CBT with another therapy included 178 patients, and had enough power to detect a differential effect size of only d=0.42. None of the trials in the 3 meta-analyses had enough power to detect effect sizes smaller than d=0.34, but some came close to the threshold for detecting a clinically relevant effect size of d=0.24. Meta-analyses may be able to solve the problem of the low power of individual trials. However, many of these studies have considerable risk of bias, and if we only focused on trials with low risk of bias, there would no longer be enough studies to detect clinically relevant effects. We conclude that individual trials are heavily underpowered and do not even come close to having sufficient power for detecting clinically relevant effect sizes. Despite this large number of trials, it is still not clear whether there are clinically relevant differences between these therapies.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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Lieb K, von der Osten-Sacken J, Stoffers-Winterling J, Reiss N, Barth J. Conflicts of interest and spin in reviews of psychological therapies: a systematic review. BMJ Open 2016; 6:e010606. [PMID: 27118287 PMCID: PMC4853969 DOI: 10.1136/bmjopen-2015-010606] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To explore conflicts of interest (COI) and their reporting in systematic reviews of psychological therapies, and to evaluate spin in the conclusions of the reviews. METHODS MEDLINE and PsycINFO databases were searched for systematic reviews published between 2010 and 2013 that assessed effects of psychological therapies for anxiety, depressive or personality disorders, and included at least one randomised controlled trial. Required COI disclosure by journal, disclosed COI by review authors, and the inclusion of own primary studies by review authors were extracted. Researcher allegiance, that is, that researchers concluded favourably about the interventions they have studied, as well as spin, that is, differences between results and conclusions of the reviews, were rated by 2 independent raters. RESULTS 936 references were retrieved, 95 reviews fulfilled eligibility criteria. 59 compared psychological therapies with other forms of psychological therapies, and 36 psychological therapies with pharmacological interventions. Financial, non-financial, and personal COI were disclosed in 22, 4 and 1 review, respectively. 2 of 86 own primary studies of review authors included in 34 reviews were disclosed by review authors. In 15 of the reviews, authors showed an allegiance effect to the evaluated psychological therapy that was never disclosed. Spin in review conclusions was found in 27 of 95 reviews. Reviews with a conclusion in favour of psychological therapies (vs pharmacological interventions) were at high risk for a spin in conclusions (OR=8.31 (1.41 to 49.05)). Spin was related in trend to the inclusion of own primary studies in the systematic review (OR=2.08 (CI 0.83 to 5.18) p=0.11) and researcher allegiance (OR=2.63 (0.84 to 8.16) p=0.16). CONCLUSIONS Non-financial COI, especially the inclusion of own primary studies into reviews and researcher allegiance, are frequently seen in systematic reviews of psychological therapies and need more transparency and better management.
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Affiliation(s)
- Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | | | | | - Neele Reiss
- Department of Differential Psychology and Psychological Assessment, Goethe-University Frankfurt, Frankfurt, Germany
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University Zurich, Zurich, Switzerland
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The enduring effects of psychodynamic treatments vis-à-vis alternative treatments: A multilevel longitudinal meta-analysis. Clin Psychol Rev 2015; 40:1-14. [DOI: 10.1016/j.cpr.2015.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 03/18/2015] [Accepted: 05/14/2015] [Indexed: 11/30/2022]
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Dragioti E, Dimoliatis I, Evangelou E. Disclosure of researcher allegiance in meta-analyses and randomised controlled trials of psychotherapy: a systematic appraisal. BMJ Open 2015; 5:e007206. [PMID: 26033943 PMCID: PMC4458582 DOI: 10.1136/bmjopen-2014-007206] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Psychotherapy research may suffer from factors such as a researcher's own therapy allegiance. The aim of this study was to evaluate if researcher allegiance (RA) was reported in meta-analyses and randomised controlled trials (RCTs) of psychotherapeutic treatments. DESIGN Systematic approach using meta-analyses of different types of psychotherapies. DATA SOURCES Medline, PsycINFO and Cochrane Database of Systematic Reviews. METHODS We evaluated meta-analyses of RCTs regarding various types of psychotherapies. Meta-analyses were eligible if they included at least one RCT with RA and they were published in journals in Medline, PsycINFO and Cochrane Database of Systematic Reviews with an impact factor larger than 5. RESULTS We identified 146 eligible meta-analyses that synthesised data from a total of 1198 unique RCTs. Only 25 of the meta-analyses (17.2%) reported allegiance and only 6 (4.1%) used a proper method to control its effect. Of the 1198 eligible primary RCTs, 793 (66.3%) were allegiant. Authors in 25 of these 793 RCTs (3.2%) reported their allegiance while only one study (0.2%) controlled for its effect. CONCLUSIONS The vast majority among a group of published meta-analyses and RCTs of psychotherapeutic treatments seldom reported and evaluated the allegiance effect. The results of the present study highlight a major lack of this information in meta-analyses and their included studies, though meta-analyses perform slightly better than RCTs. Stringent guidelines should be adopted by journals in order to improve reporting and attenuate possible effects of RA in future research.
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Affiliation(s)
- Elena Dragioti
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, University Campus, Ioannina, Greece
| | - Ioannis Dimoliatis
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, University Campus, Ioannina, Greece
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, University Campus, Ioannina, Greece
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
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Smith JD, Stormshak EA, Kavanagh K. Results of a pragmatic effectiveness-implementation hybrid trial of the Family Check-up in community mental health agencies. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 42:265-78. [PMID: 24927926 PMCID: PMC4265575 DOI: 10.1007/s10488-014-0566-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study reports the results of a pragmatic effectiveness-implementation hybrid trial of the Family Check-Up (FCU) conducted in three community mental health agencies with 40 participating therapists. Seventy-one families with children between 5 and 17 years of age participated. Intervention fidelity and level of adoption were acceptable; families reported high service satisfaction; and therapists reported high acceptability. Families in the FCU condition experienced significantly reduced youth conduct problems in comparison to usual care and completion of the FCU resulted in larger effects. This study provides promising evidence that implementing the FCU in community mental health agencies has the potential to improve youth behavior outcomes.
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Affiliation(s)
- Justin D Smith
- Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798, USA,
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Timimi S. Children and Young People's Improving Access to Psychological Therapies: inspiring innovation or more of the same? BJPsych Bull 2015; 39:57-60. [PMID: 26191433 PMCID: PMC4478906 DOI: 10.1192/pb.bp.114.047118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/26/2014] [Accepted: 06/09/2014] [Indexed: 11/23/2022] Open
Abstract
In 2007 the UK Government announced a substantial expansion of funding for psychological therapies for those presenting with common mental health problems. This 'Improving Access to Psychological Therapies' (IAPT) project was widely welcomed, however, evidence backed, economic, and conceptual critiques were voiced from the start and the project remains controversial. In 2011, the UK government announced it was extending the IAPT project to encompass services for children and young people with the aim of 'transforming' the way mental health services are delivered to them. Here I critically reflect on the problems associated first with IAPT and then with CYP-IAPT and ponder whether CYP-IAPT is significantly different to the problematic adult IAPT project or more of the same.
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Luyten P. Unholy Questions About Five Central Tenets of Psychoanalysis That Need to be Empirically Verified. PSYCHOANALYTIC INQUIRY 2015. [DOI: 10.1080/07351690.2015.987590] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Budge SL, Wampold BE. The Relationship: How It Works. Psychother Res 2015. [DOI: 10.1007/978-3-7091-1382-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kongerslev MT, Chanen AM, Simonsen E. Personality Disorder in Childhood and Adolescence comes of Age: a Review of the Current Evidence and Prospects for Future Research. Scand J Child Adolesc Psychiatr Psychol 2015. [DOI: 10.21307/sjcapp-2015-004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Dragioti E, Dimoliatis I, Fountoulakis KN, Evangelou E. A systematic appraisal of allegiance effect in randomized controlled trials of psychotherapy. Ann Gen Psychiatry 2015; 14:25. [PMID: 26379758 PMCID: PMC4570291 DOI: 10.1186/s12991-015-0063-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/21/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Experimenter's allegiance (EA) refers to a personal confidence of the superiority of a specific psychotherapy treatment. This factor has been linked with larger treatment effects in favor of the preferred treatment. However, various studies have displayed contradictory results between EA and the pattern of treatment effects. AIMS Using a systematic approach followed by meta-analysis, we aimed to evaluate the impact of an allegiance effect on the results of psychotherapeutic studies. METHOD We considered the meta-analyses of randomized controlled trials (RCTs) of different types of psychotherapies in the Cochrane Database of Systematic Reviews. Eligible articles included meta-analyses of RCTs with at least one study showing evidence of EA (i.e., allegiant study). Effect sizes in allegiant RCTs were compared with non-allegiant using random and fixed models and a summary relative odds ratio (ROR) were calculated. Heterogeneity was quantified with the I (2) metric. RESULTS A total of 30 meta-analyses including 240 RCTs were analyzed. The summary ROR was 1.31 [(95 % confidence interval (CI: 1.03-1.66) P = 0.30, I (2) = 53 %] indicating larger effects when allegiance exists. The impact of allegiance did not differ significantly (P > 0.05) when we compared psychiatric versus medical outcomes. Allegiance effect was significant for all forms of psychotherapy except for cognitive behavioral therapy. Moreover, the impact of allegiance was significant only when the treatment integrity of delivered psychotherapy was not assessed. Allegiance effect was even stronger where the experimenter was also both the developer of the preferred treatment and supervised or trained the therapists. No significant differences were found between allegiant and non-allegiant studies in terms of overall quality of studies. CONCLUSIONS Experimenter's allegiance influences the effect sizes of psychotherapy RCTs and can be considered non-financial conflict of interest introducing a form of optimism bias, especially since blinding is problematic in this kind of research. A clear reporting of EA in every single study should be given an opportunity to investigators of minimizing its overestimation effects.
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Affiliation(s)
- Elena Dragioti
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece ; Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Pain and Rehabilitation Center, Anesthetics, Operations and Specialty Surgery Center, County Council of Östergötland, 58185 Linköping, Sweden
| | - Ioannis Dimoliatis
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece ; Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
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Rousseau C, Nadeau L, Pontbriand A, Johnson-Lafleur J, Measham T, Broadhurst J. La santé mentale jeunesse : un domaine à la croisée des chemins. SANTE MENTALE AU QUEBEC 2014. [DOI: 10.7202/1025909ar] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Si l’importance grandissante de la santé mentale des jeunes fait consensus, de multiples questionnements émergent cependant quant aux spécificités de ce domaine, qui ne peut être conçu comme une extension des services adultes pour des groupes plus jeunes. Cet article aborde ces questionnements en croisant les savoirs provenant de la documentation et ceux qui émergent à la suite de l’implantation du Plan d’action en santé mentale au Québec.
Le Plan d’action en santé mentale a mis de l’avant la collaboration et le partenariat entre institutions et disciplines. Malgré des avancées significatives, des discontinuités peu favorables à une prise en charge écosystémique persistent. Un ensemble de recherches récentes suggère que les contextes organisationnels qui encadrent les services influencent à la fois la façon dont les interventions sont mises en place et leurs résultats cliniques. Une structure de gestion flexible qui engage les intervenants en favorisant une appropriation du pouvoir, tout en minimisant les sources de stress au travail et en facilitant la création de partenariats, semble nécessaire pour favoriser la concertation interdisciplinaire et intersectorielle. Celle-ci est essentielle à la mise en place de services en santé mentale jeunesse.
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Affiliation(s)
- Cécile Rousseau
- Professeur titulaire, Université McGill
- CSSS de la Montagne (CLSC de Parc-Extension)
| | | | | | | | | | - Joanna Broadhurst
- Chef de programme DI/TED DP et santé mentale jeunesse CSSS de la Montagne
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Schmidt HM, Munder T, Gerger H, Frühauf S, Barth J. Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: a narrative review and meta-analysis. J Sex Med 2014; 11:1376-91. [PMID: 24641632 DOI: 10.1111/jsm.12520] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is an increasing health problem that demands effective treatment. There is evidence that phosphodiesterase-5 inhibitors (PDE5-Is) and psychological intervention (PI) are effective treatment options; however, little is known about their comparative efficacy and the efficacy of combined treatments. AIM The aim of this systematic review and meta-analysis is to evaluate the comparative efficacy of PI, PDE5-Is, and their combination in the treatment of ED. MAIN OUTCOME MEASURES Primary outcome was ED symptoms, and secondary outcome was sexual satisfaction of the patient. METHODS A systematic literature search was conducted in order to identify relevant articles published between 1998 and 2012. We included randomized controlled trials and controlled trials comparing PI with PDE5-I treatment or one of them against a combination of both. RESULTS Eight studies with a total number of 562 patients were included in the meta-analysis. The results of the included studies are inconclusive, though they show a trend towards a larger effect of combined treatment compared with PI or PDE5-I treatment alone. The meta-analysis found that, overall, combined treatment was more efficacious for ED symptoms than PDE5-I treatment or PI alone. Combined treatment was more efficacious than PDE5-I use alone on sexual satisfaction. No differences were found between PDE5-Is and PI as stand-alone treatments. None of the moderators (treatment duration, methodological quality, or researcher allegiance) altered the effects. CONCLUSIONS The combination of PI and PDE5-Is is a promising strategy for a favorable outcome in ED and can be considered as a first-choice option for ED patients. Stronger RCTs are required to confirm this initial finding.
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Affiliation(s)
- Hannah M Schmidt
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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van Oenen FJ, Schipper S, Van R, Schoevers R, Visch I, Peen J, Dekker J. Efficacy of immediate patient feedback in emergency psychiatry: a randomized controlled trial in a crisis intervention & brief therapy team. BMC Psychiatry 2013; 13:331. [PMID: 24305085 PMCID: PMC4235197 DOI: 10.1186/1471-244x-13-331] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study looks at the effect of immediate session-by-session feedback using short questionnaires for evaluating outcome of and alliance in the therapy. Research data strongly suggests that using this feedback informed treatment improves the outcome of therapy. However, until now, this method of Miller and Duncan has only been examined in clients (generally students) with mild problems and in partner counselling. The question addressed by this study is whether immediate feedback is also effective when applied during crisis intervention and subsequent brief therapy in a psychiatric patient population in emergency situations. It also looks at whether 'feedback-informed treatment' affects the quality of the alliance. METHOD/DESIGN To test the hypotheses, all patients seeking help from the Crisis Intervention & Brief Therapy Team over a two-year period will be followed throughout their treatment up to a maximum of six months and a follow-up period of three months after ending the treatment. Patients are randomly assigned to two conditions: treatment without feedback and treatment with immediate feedback for each session. The therapists all operate in both conditions and so they deliver both treatments. An estimated total of 180 patients, aged 18 years and over, will be included in the study. DISCUSSION The aim of this study is to make clear whether, and to what extent, systematic feedback from the patient in this target group during therapy determines the course and outcomes of therapy. We also look at whether, and to what extent, the quality of the alliance and the motivation of the person delivering treatment with respect to the instruments play a role. TRIAL REGISTRATION NTR3168.
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Affiliation(s)
| | - Suzy Schipper
- Arkin, Klaprozenweg 111, 1033 Amsterdam, NN, The Netherlands
| | - Rien Van
- Arkin, Klaprozenweg 111, 1033 Amsterdam, NN, The Netherlands
| | - Robert Schoevers
- Universitair Medisch Centrum Groningen, Hanzeplein 1, 9713 Groningen, GZ, The Netherlands
| | - Irene Visch
- Arkin, Klaprozenweg 111, 1033 Amsterdam, NN, The Netherlands
| | - Jaap Peen
- Arkin, Klaprozenweg 111, 1033 Amsterdam, NN, The Netherlands
| | - Jack Dekker
- Arkin, Klaprozenweg 111, 1033 Amsterdam, NN, The Netherlands,Klinische Psychologie Vrije Universiteit van Amsterdam, de Boelelaan 1105, 1081 Amsterdam, HV, The Netherlands
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Budge SL, Moore JT, Del Re A, Wampold BE, Baardseth TP, Nienhuis JB. The effectiveness of evidence-based treatments for personality disorders when comparing treatment-as-usual and bona fide treatments. Clin Psychol Rev 2013; 33:1057-66. [DOI: 10.1016/j.cpr.2013.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 07/03/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
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Cooper M, Stewart D, Sparks J, Bunting L. School-based counseling using systematic feedback: A cohort study evaluating outcomes and predictors of change. Psychother Res 2013; 23:474-88. [DOI: 10.1080/10503307.2012.735777] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Braun SR, Gregor B, Tran US. Comparing bona fide psychotherapies of depression in adults with two meta-analytical approaches. PLoS One 2013; 8:e68135. [PMID: 23840824 PMCID: PMC3695954 DOI: 10.1371/journal.pone.0068135] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/25/2013] [Indexed: 01/20/2023] Open
Abstract
Objective Despite numerous investigations, the question whether all bona fide treatments of depression are equally efficacious in adults has not been sufficiently answered. Method We applied two different meta-analytical techniques (conventional meta-analysis and mixed treatment comparisons). Overall, 53 studies with 3,965 patients, which directly compared two or more bona fide psychotherapies in a randomized trial, were included. Meta-analyses were conducted regarding five different types of outcome measures. Additionally, the influence of possible moderators was examined. Results Direct comparisons of cognitive behavior therapy, behavior activation therapy, psychodynamic therapy, interpersonal therapy, and supportive therapies versus all other respective treatments indicated that at the end of treatment all treatments but supportive therapies were equally efficacious whereas there was some evidence that supportive therapies were somewhat less efficacious than all other treatments according to patient self-ratings and clinical significance. At follow-up no significant differences were present. Age, gender, comorbid mental disorders, and length of therapy session were found to moderate efficacy. Cognitive behavior therapy was superior in studies where therapy sessions lasted 90 minutes or longer, behavior activation therapy was more efficacious when therapy sessions lasted less than 90 minutes. Mixed treatment comparisons indicated no statistically significant differences in treatment efficacy but some interesting trends. Conclusions This study suggests that there might be differential effects of bona fide psychotherapies which should be examined in detail.
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Spielmans GI, Benish SG, Marin C, Bowman WM, Menster M, Wheeler AJ. Specificity of psychological treatments for bulimia nervosa and binge eating disorder? A meta-analysis of direct comparisons. Clin Psychol Rev 2013; 33:460-9. [DOI: 10.1016/j.cpr.2013.01.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 12/30/2012] [Accepted: 01/19/2013] [Indexed: 01/23/2023]
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Baardseth TP, Goldberg SB, Pace BT, Wislocki AP, Frost ND, Siddiqui JR, Lindemann AM, Kivlighan DM, Laska KM, Del Re AC, Minami T, Wampold BE. Cognitive-behavioral therapy versus other therapies: Redux. Clin Psychol Rev 2013; 33:395-405. [DOI: 10.1016/j.cpr.2013.01.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 11/28/2012] [Accepted: 01/09/2013] [Indexed: 12/30/2022]
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Timimi S, Tetley D, Burgoine W, Walker G. Outcome Orientated Child and Adolescent Mental Health Services (OO-CAMHS): a whole service model. Clin Child Psychol Psychiatry 2013; 18:169-84. [PMID: 22548827 DOI: 10.1177/1359104512444118] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The international evidence base on factors that most influence outcomes in mental health care finds that matching therapeutic intervention to diagnosis has a clinically insignificant impact on outcomes. Decades of outcome research into treatment of psychiatric disorders shows that, despite the development of many new techniques, the outcomes being achieved in studies 30 years ago are similar to those being achieved now. In the last few years, new service models that incorporate systems of feedback on progress and alliance have emerged and show promise with regards improving overall outcomes for mental health service users. Growing familiarity with this outcome literature, together with a desire to be part of a service that can continue to improve patient outcomes, led a small community Child and Adolescent Mental Health Services team to develop a new whole service model - Outcome Orientated Child and Adolescent Mental Health Services (OO-CAMHS). OO-CAMHS incorporates key aspects of the evidence base on what could make a differential positive impact on outcomes and relinquishes those aspects that do not. In this paper, we outline the evidence base on which OO-CAMHS is built, describe the key features of the approach and present some of the early findings on its impact.
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Affiliation(s)
- Sami Timimi
- Faculty of Life, Health, and Social Sciences, University of Lincoln, UK.
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Munder T, Brütsch O, Leonhart R, Gerger H, Barth J. Researcher allegiance in psychotherapy outcome research: an overview of reviews. Clin Psychol Rev 2013; 33:501-11. [PMID: 23500154 DOI: 10.1016/j.cpr.2013.02.002] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/10/2013] [Accepted: 02/12/2013] [Indexed: 11/29/2022]
Abstract
Researcher allegiance (RA) is widely discussed as a risk of bias in psychotherapy outcome research. The relevance attached to RA bias is related to meta-analyses demonstrating an association of RA with treatment effects. However, recent meta-analyses have yielded mixed results. To provide more clarity on the magnitude and robustness of the RA-outcome association this article reports on a meta-meta-analysis summarizing all available meta-analytic estimates of the RA-outcome association. Random-effects methods were used. Primary study overlap was controlled. Thirty meta-analyses were included. The mean RA-outcome association was r=.262 (p=.002, I(2)=28.98%), corresponding to a moderate effect size. The RA-outcome association was robust across several moderating variables including characteristics of treatment, population, and the type of RA assessment. Allegiance towards the RA bias hypothesis moderated the RA-outcome association. The findings of this meta-meta-analysis suggest that the RA-outcome association is substantial and robust. Implications for psychotherapy outcome research are discussed.
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Affiliation(s)
- Thomas Munder
- Institute of Social and Preventive Medicine, University of Bern, Switzerland.
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Smith DC. Jacquelines of all trades or masters of some? Negative implications of focusing on common factors. SOCIAL WORK 2012; 57:283-287. [PMID: 23252319 DOI: 10.1093/sw/sws038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The emphasis on common factors initially grew out of increasingly frustrating findings from randomized clinical trials that head-to-head comparison of different treatments rarely found one to be superior (Luborsky et al., 2002; Luborsky, Singer, & Luborsky, 1975). In this regard, Cameron and Keenan (2010) have done well calling attention to a fundamental problem we deal with in researching, practicing, and teaching. As an instructor, it is difficult to teach practice- minded MSW students about empirically supported treatments when, with few exceptions, most theoretically distinct treatments that have been contrasted are not so different in terms of outcomes. This beckons us to teach students to think critically and understand the limits of current research on empirically supported treatments. However, I have argued here that there are benefits to teaching students about specific ESTs. It is plausible that providing extensive training in specific ESTs could be a platform for teaching about common factors, rather than focusing on developing generalist skills and later learning specific techniques that are needed in certain practice areas. Doing so gives students some useful techniques, which are associated with clinical improvement and can be adapted to other practice settings. It is unclear if the same can be said for teaching a common factors approach, which is already the dominant training model in social work. Of course, empirical research is needed to determine whether varying degrees of training emphasis on common factors or specific ESTs affect clinical skill development or adoption of ESTs. With regard to the issue of common factors in clinical research, health services researchers are already being encouraged to propose novel techniques for how we might affect common factors. Although it is clear that such mechanisms are not always unique to particular treatments, such research is typically being done incrementally by studying in-session processes operating within particular treatments or by isolating the relative contribution of elements of evidence-based treatments. Such studies can identify important techniques that are useful in clinical practice in multiple contexts, which then can be taught to practitioners. It is unclear if the study of general common factors can produce information that validates the use of particular techniques or if such research is compelling enough for stakeholders to accept unspecified eclectic practice as empirically supported. In conclusion, training on specific ESTs may be an ideal goal in social work education, and the common factors research most likely to inform practice will probably be done in the context of studying specific ESTs. Additional research is needed on the barriers that impede such training and whether such efforts result in more wide-spread adoption of EBPs in social work practice. Compared with focusing on a transtheoretical common factors approach, any movement toward teaching specific ESTs in the classroom would truly be a paradigm shift.
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Affiliation(s)
- Douglas C Smith
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
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Where is the Dialogue? A Social Constructionist View of Empirically Supported Treatments. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2012. [DOI: 10.1177/008124631204200113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the publication of the list of empirically supported treatments by the American Psychological Association in 1995 a controversy has resulted between those who view positive psychotherapeutic outcome as resulting from the use of specific (listed) techniques and those who lean towards the so-called common or relationship factors rather than particular techniques as necessary for such outcomes. This paper examines the controversy and shows that both sides follow the same objectivist/empiricist and reductionist epistemology. In contrast, the paper adopts a social constructionist perspective and shows that the idea of therapeutic outcome as linearly determined by either technical or common factors or a combination of these is a misleading oversimplification which fails to account for the dialogue which is the core of psychotherapy. Rather, positive outcome is viewed as mutually constructed in a unique dialogue which encompasses both common and technical factors. This takes the form of the conversational development of a new understanding or reframe of the problem followed by action which is deemed appropriate to the new understanding. This view is illustrated by practical examples.
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Siegenthaler E, Munder T, Egger M. Effect of preventive interventions in mentally ill parents on the mental health of the offspring: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 2012; 51:8-17.e8. [PMID: 22176935 DOI: 10.1016/j.jaac.2011.10.018] [Citation(s) in RCA: 236] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 10/26/2011] [Accepted: 10/28/2011] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Mental illness in parents affects the mental health of their children. A systematic review and a meta-analysis of the effectiveness of interventions to prevent mental disorders or psychological symptoms in the offspring were performed. METHOD The Cochrane, MEDLINE, EMBASE, and PsycINFO databases were searched for randomized controlled trials of interventions in parents with mental disorders. Outcomes in the child included incident mental disorders of the same nature and internalizing (negative emotions, depressive symptoms, anxiety) or externalizing (hyperactivity, aggressiveness, behavioral problems) symptoms. Relative risks and standardized mean differences in symptom scores were combined in random-effects meta-analysis. RESULTS Thirteen trials including 1,490 children were analyzed. Interventions included cognitive, behavioral, or psychoeducational components. Seven trials assessed the incidence of mental disorders and seven trials assessed symptoms. In total 161 new diagnoses of mental illness were recorded, with interventions decreasing the risk by 40% (combined relative risk 0.60, 95% CI 0.45-0.79). Symptom scores were lower in the intervention groups: standardized mean differences were -0.22 (95% CI -0.37 to -0.08) for internalizing symptoms (p = .003) and -0.16 (95% confidence interval -0.36 to 0.04) for externalizing symptoms (p = .12). CONCLUSIONS Interventions to prevent mental disorders and psychological symptoms in the offspring of parents with mental disorders appear to be effective.
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Whiston SC, Li P. Meta-Analysis: A Systematic Method for Synthesizing Counseling Research. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6678.2011.tb00089.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Reese RJ, Prout HT, Zirkelback EH, Anderson CR. Effectiveness of school-based psychotherapy: A meta-analysis of dissertation research. PSYCHOLOGY IN THE SCHOOLS 2010. [DOI: 10.1002/pits.20522] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Zirkelback EA, Reese RJ. A review of psychotherapy outcome research: Considerations for school-based mental health providers. PSYCHOLOGY IN THE SCHOOLS 2010. [DOI: 10.1002/pits.20526] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kelley SD, de Andrade ARV, Sheffer E, Bickman L. Exploring the black box: measuring youth treatment process and progress in usual care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 37:287-300. [PMID: 20238155 DOI: 10.1007/s10488-010-0298-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The session report form (SRF) is a 25-item self-report measure scheduled to be completed by clinicians at the end of each session. This study addresses the utility of the SRF for describing session content by exploring patterns of self-reported behavior of 235 clinicians in 7,058 sessions with 600 clients. Results indicate that the SRF has a distinct subscale of treatment process and provides an adequate range of topics related to session content while also discriminating between client and clinician influences on patterns of topics addressed. The SRF is a promising measure meeting a significant need in describing session content in usual care.
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Affiliation(s)
- Susan Douglas Kelley
- Center for Evaluation and Program Improvement, Vanderbilt University, Nashville, TN 37203-5721, USA.
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