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Lee R, McMillan D, Delgadillo J, Alexander R, Lucock M. Cognitive change before sudden gains in cognitive behavioural therapy for panic disorder. Behav Cogn Psychother 2024; 52:107-118. [PMID: 37821240 DOI: 10.1017/s1352465823000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Sudden gains occur in a range of disorders and treatments and are of clinical and theoretical significance if they can shed light on therapeutic change processes. This study investigated the relationship between sudden gains in panic symptoms and preceding cognitive change during cognitive behavioural therapy (CBT) for panic disorder. METHOD Participants with panic disorder completed in session measures of panic symptoms and catastrophic cognitions. Independent samples t-tests were used to compare the post-treatment score of those who met criteria for one or more sudden gain during treatment with those who did not, and to compare within-session cognitive change between pre-sudden gain sessions and the previous (control) session. RESULTS Twenty-two (42%) of 53 participants experienced a sudden gain during treatment. Participants demonstrating a sudden gain showed more improvement in panic symptoms from pre- to post-treatment than those without a sudden gain. The within-session cognitive change score in the pre-gain session was significantly greater than in the control session. CONCLUSIONS Sudden gains occurred in individual CBT for panic disorder and within-session cognitive change was associated with sudden gains. This is consistent with the cognitive model of panic disorder and highlights how sudden gains can help to identify key change processes.
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Affiliation(s)
- Rachel Lee
- South West Yorkshire Partnership NHS Foundation Trust, Fieldhead, Wakefield, UK
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, Mental Health and Addiction Research Group, University of York, Heslington, York, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Rachael Alexander
- South West Yorkshire Partnership NHS Foundation Trust, Fieldhead, Wakefield, UK
| | - Mike Lucock
- University of Huddersfield, Huddersfield, UK
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2
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Af Winklerfelt Hammarberg S, Toth-Pal E, Jansson-Fröjmark M, Lundgren T, Westman J, Bohman B. Intolerance-of-uncertainty therapy versus metacognitive therapy for generalized anxiety disorder in primary health care: A randomized controlled pilot trial. PLoS One 2023; 18:e0287171. [PMID: 37315099 DOI: 10.1371/journal.pone.0287171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE This randomized controlled pilot study investigated the feasibility of a future full-scale RCT to compare the effects of intolerance-of-uncertainty therapy (IUT) and metacognitive therapy (MCT) in primary health care patients with generalized anxiety disorder (GAD). Preliminary treatment effects were also evaluated. MATERIALS AND METHODS 64 patients with GAD at a large primary health care center in Stockholm, Sweden, were randomized to IUT or MCT. Feasibility outcomes included participant recruitment and retention, willingness to receive psychological treatment, and therapists' competence in and adherence to treatment protocols. Self-reported scales were used to assess treatment outcomes, including worry, depression, functional impairment, and quality of life. RESULTS Recruitment was satisfactory, and dropout was low. On a scale from 0 to 6, participants were satisfied with participating in the study (M = 5.17, SD = 1.09). Following brief training, therapists' competence was rated as moderate, and adherence was rated as weak to moderate. From pre- to post-treatment, reductions on the primary treatment outcome measure of worry were of a large effect size and statistically significant in both the IUT and MCT conditions (Cohen's d for IUT = -2.69, 95% confidence interval [-3.63, -1.76] and d for MCT = -3.78 [-4.68, -2.90]). The between-group effect size from pre- to post-treatment was large and statistically significant (d = -2.03 [-3.31, -0.75]), in favor of the MCT condition. CONCLUSION It is feasible to carry out a full-scale RCT to compare the effects of IUT to MCT for patients with GAD in primary health care. Both protocols seem effective, and MCT seems superior to IUT, but a full-scale RCT is needed to confirm these conclusions. TRIAL REGISTRATION ClinicalTrials.gov (no. NCT03621371).
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Affiliation(s)
- Sandra Af Winklerfelt Hammarberg
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Eva Toth-Pal
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Jeanette Westman
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- The Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Benjamin Bohman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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3
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de Vries FS, van Dongen RTM, Bertens D. Pain education and pain management skills in virtual reality in the treatment of chronic low back pain: A multiple baseline single-case experimental design. Behav Res Ther 2023; 162:104257. [PMID: 36731183 DOI: 10.1016/j.brat.2023.104257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/19/2023]
Abstract
Chronic lower back pain is a major health problem and current treatments do not always lead to adequate pain control. Virtual reality (VR) is an upcoming technology that has shown to be effective in reducing acute pain. However, the value of VR in reducing chronic pain is still unknown. Therefore, the current study focuses on the effects of a recently developed VR application 'Reducept' using a multiple baseline single-case experimental design in 8 patients (N = 8). Reducept is a VR-training program aiming to improve pain management skills and providing pain education in patients with (chronic lower) back pain. Results based on visual and statistical analyses indicated that Reducept has the potential to reduce chronic lower back pain, although its clinical relevance was small. This study is one of the first that focuses on the possible effects of Reducept using sophisticated visual and statistical analyses. Our study shows a detailed overview of individual changes in pain intensity over time. Further research is necessary to investigate the working mechanism of Reducept and its impact on chronic pain conditions.
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Affiliation(s)
- Froukje S de Vries
- Canisius-Wilhelmina Medical Center, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands.
| | - Robert T M van Dongen
- Canisius-Wilhelmina Medical Center, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands; Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525GA, Nijmegen, the Netherlands
| | - Dirk Bertens
- Klimmendaal Rehabilitation Specialists, Heijenoordseweg 5, 6813 GG, Arnhem, the Netherlands; Radboud University, Donders Institute for Brain, Cognition and Behaviour, Thomas van Aquinostraat 4, 6525 GD, Nijmegen, the Netherlands
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4
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What are patients completing Cognitive Behavioral Insomnia Therapy telling us with their post-treatment Insomnia Severity Index scores? Sleep Med 2023; 103:187-194. [PMID: 36841218 DOI: 10.1016/j.sleep.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/25/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
STUDY OBJECTIVE Cognitive Behavioral Insomnia Therapy (CBT-I) is the gold standard insomnia treatment and the Insomnia Severity Index (ISI) is a frequently used treatment outcome measure. The ISI has strong psychometric properties and is purported to measure perceived insomnia symptom severity. However, little is known about the factors that drive insomnia severity perception and the psychometric properties of the ISI post-CBT-I. METHODS Participants were treatment-seeking adults meeting DSM-5 Insomnia Disorder criteria (n = 203, ages 18-77, M = 45.95 years). Participants completed sleep and mood questionnaires, including the ISI, pre- and post-CBT-I. They completed daily Consensus Sleep Diaries each morning throughout two pre-treatment weeks, eight weeks of treatment and two weeks post-treatment. A hierarchical regression analysis examined what predicted post-CBT-I ISI scores and Cronbach's alpha was computed to examine post-treatment reliability of the ISI. RESULTS The regression analysis revealed that lower post-treatment ISI scores were associated with lower pre-treatment ISI, and greater decreases in fatigue and generalized anxiety symptoms. The model did not significantly improve when pre-treatment sleep effort or changes in sleep diary indices were added. The post-treatment ISI Cronbach's alpha was .88. CONCLUSIONS Although the ISI has been shown to have sound psychometric properties, clinicians should consider that post CBT-I ISI scores are not related to their sleep improvements. Instead, they seem to be related to whether patients perceive themselves as poor sleepers pre-treatment and whether they felt less tired and anxious after CBT-I. Researchers should consider the impact of factors other than sleep when using the ISI at post-treatment. Patients are telling us that CBT-I should focus on addressing symptoms of fatigue and general anxiety; perhaps CBT-I could be improved further to address these concerns more effectively. SUMMARY This investigation shows that when individuals are rating their symptom severity after CBT-I, they are also integrating how they felt before treatment and whether they experienced a change in their fatigue or anxiety.
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Psychodrama as an Intervention Management Instrument for Internal/External Adolescent Problems: A Systematic Literature Review. ARTS IN PSYCHOTHERAPY 2023. [DOI: 10.1016/j.aip.2023.102000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Hill RM, Oosterhoff B, King CA, Kaplow JB. Open trial of a brief,
web‐assisted
behavioural intervention to reduce thwarted belongingness and suicidal ideation among adolescents: The Supporting Grieving Teens intervention. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ryan M. Hill
- Department of Psychology The University of Texas at San Antonio San Antonio Texas USA
| | | | - Cheryl A. King
- Departments of Psychiatry and Psychology The University of Michigan Ann Arbor Michigan USA
| | - Julie B. Kaplow
- The Trauma and Grief Center at The Hackett Center for Mental Health Houston Texas USA
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7
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Schaeuffele C, Homeyer S, Perea L, Scharf L, Schulz A, Knaevelsrud C, Renneberg B, Boettcher J. The unified protocol as an internet-based intervention for emotional disorders: Randomized controlled trial. PLoS One 2022; 17:e0270178. [PMID: 35816479 PMCID: PMC9273095 DOI: 10.1371/journal.pone.0270178] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/31/2022] [Indexed: 01/04/2023] Open
Abstract
The Unified Protocol (UP) as a transdiagnostic intervention has primarily been applied in the treatment of anxiety disorders and in face-to-face-settings. The current study investigated the efficacy of a 10-week Internet-based adaptation of the UP for anxiety, depressive, and somatic symptom disorders. The trial was registered under DRKS00014820 at the German Clinical Trial Registry, DRKS. Participants (n = 129) were randomized to treatment or waitlist control. Significant treatment effects were found for symptom distress, satisfaction with life, positive/negative affect and markers of anxiety, depression, and somatic symptom burden (within-group Hedges’ g = 0.32–1.38 and between-group g = 0.20–1.11). Treatment gains were maintained at 1- and 6-month-follow-up. Subgroup analyses showed comparable effects in participants with anxiety and depressive disorders. 26.6% dropped out of treatment and 35.38% did not provide post-treatment assessments. The results strengthen the application of the UP as an Internet-based treatment for alleviating symptom distress across emotional disorders. More research on the applicability for single disorders is needed and avenues to improve adherence and attrition rates should be explored.
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Affiliation(s)
- Carmen Schaeuffele
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- * E-mail:
| | - Sophie Homeyer
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Luis Perea
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Lisa Scharf
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Ava Schulz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zürich, Switzerland
| | | | - Babette Renneberg
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Johanna Boettcher
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
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8
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Park K, Kim G, Lee J, Suh S. Differences in Treatment Effects of Cognitive-behavioral Therapy for Insomnia Based on Sleep Reactivity: A Preliminary Study. Behav Sleep Med 2022; 21:332-343. [PMID: 35754367 DOI: 10.1080/15402002.2022.2093880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Sleep reactivity is the trait-like degree to which stress disrupts sleep, resulting in difficulty falling and staying asleep. Although previous studies have suggested that individuals who have high sleep reactivity may be resistant to cognitive-behavioral therapy for insomnia (CBT-I) effects, there have been no studies that have investigated this empirically. This study explored differential treatment responses in CBT-I based on sleep reactivity levels. MATERIAL AND METHOD Participants for this study were nineteen insomnia patients who met DSM-5 criteria for insomnia disorder. All participants received four weekly sessions of structured cognitive-behavioral therapy for insomnia (CBT-I). Individuals completed the Insomnia Severity Index (ISI), Korean version of Center for Epidemiologic Studies Depression Scale-Revised (K-CESD-R), Ford Insomnia Response to Stress Test (FIRST), Dysfunctional Beliefs and Attitudes about Sleep Scale-16 (DBAS-16), the Daily Inventory of Stressful Events (DISE) and a sleep diary. Participants were classified into two groups based on sleep reactivity level (high and low sleep reactivity). RESULT Following treatment, significant changes were found for ISI, K-CESD-R, DBAS-16 and FIRST scores, sleep onset latency, wake after sleep onset, sleep efficiency, number of awakenings, sleep quality and feeling refreshed upon awakening in both groups. Improvements in sleep efficiency was lower in the high sleep reactivity group compared to the low sleep reactivity group. No differences in ISI, K-CESD-R, DBAS-16 scores, and stress event frequency during the treatment duration were found between groups. CONCLUSION These findings suggest that sleep reactivity level may be an important factor that affects treatment outcome of CBT-I. Furthermore, the results may suggest that individual response to stress events are more important than the stressor itself.
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Affiliation(s)
- Kyunga Park
- Department of Psychology, Sungshin University, Seongbuk-gu, Republic of Korea
| | - Goeun Kim
- Department of Psychology, Sungshin University, Seongbuk-gu, Republic of Korea
| | - Jiyun Lee
- Department of Psychology, Sungshin University, Seongbuk-gu, Republic of Korea
| | - Sooyeon Suh
- Department of Psychology, Sungshin University, Seongbuk-gu, Republic of Korea
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9
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Kelly PJ, Coyte J, Robinson LD, Deane FP, Russell S, Clapham K, Dale E, Longbottom M, Solley R, Baker AL. Evaluating an Aboriginal community controlled residential alcohol and other drug services: Use of benchmarking to examine within treatment changes in wellbeing. Drug Alcohol Rev 2022; 41:953-962. [PMID: 35106858 DOI: 10.1111/dar.13432] [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: 02/13/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Aboriginal Community Controlled Organisations (ACCO) have an important role in the Australian health-care sector. However, there has been a lack of research evaluating ACCOs in the treatment of alcohol and other drug (AOD) use. Using a benchmarking approach, the present study examined within treatment changes on measures of wellbeing for people attending a residential AOD ACCO. METHODS The study focused on The Glen, an AOD residential treatment service that is managed by the Ngaimpe Aboriginal Corporation (n = 775). The Glen is a male-only service and provides treatment to both Indigenous and non-Indigenous men. The evaluation focused on measures of wellbeing (i.e. symptom distress and quality of life) collected at intake, 30 and 60 days during the person's stay. Comparative benchmarking was conducted with a cohort of men who were attending non-ACCO residential AOD treatment services (n = 4457). RESULTS The Glen participants demonstrated statistically significant improvements on measures of wellbeing. The Glen participants were more likely to complete treatment than participants attending non-ACCO services. Likewise, Indigenous people attending The Glen were more likely to complete treatment (compared to Indigenous people attending non-ACCO services). Rates of reliable and clinically significant change suggested that changes in quality of life were largely equivalent between The Glen and non-ACCO services, while participants attending The Glen tended to demonstrate larger reductions in symptom distress compared to the non-ACCO services. DISCUSSION AND CONCLUSION The study provides further support for the important role that ACCOs play in supporting Indigenous people in their recovery.
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Affiliation(s)
- Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Joe Coyte
- The Glen, Central Coast Alcohol and Drug Rehabilitation Centre, Ngaimpe Aboriginal Corporation, Chittaway Point, Australia
| | - Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Sophie Russell
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Kathleen Clapham
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Elizabeth Dale
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.,Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Marlene Longbottom
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Ryan Solley
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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10
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Reliable change and the reliable change index: still useful after all these years? COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
In 1984 Jacobson and colleagues introduced the concept of reliable change, viz the amount of change on a measure that an individual needed to show to determine that it exceeded the extent of change likely due to measurement error alone. Establishing reliable change was a pre-requisite for determining clinical significance. This paper summarizes the rationale for determining reliable change as providing an individual-focused, idiographic alternative to the dominant nomothetic approach to clinical outcome research based on group mean data and statistical significance. The conventional computational steps for calculating an individual’s standardized difference (reliable change) score and the minimum raw change score on the measure (a reliable change index) required to classify individuals as reliably positively changed, indeterminate, or reliably deteriorated are described. Two methods for graphically representing reliable change are presented, and a range of possible uses in both research and practice settings are summarized. A number of issues and debates concerning the calculation of reliable change are reviewed. It is concluded that the concept of reliable change remains useful for both cognitive behavioural researchers and practitioners, but that there are options regarding methods of computation. In any use of reliable change, the rationale for selecting among method options and the exact computations used need clear and careful description so that we can continuously judge the utility and appropriateness of the use of reliable change and enhance its value to the field.
Key learning aims
(1)
Recognizing why the concept of reliable change and the reliable change index is still important.
(2)
Understanding the conventional formulas for calculating reliable change and the reliable change index (the Jacobson-Truax (JT) method).
(3)
Seeing key ways that both researchers and practitioners can use reliable change to improve both research and practice.
(4)
Understanding how several issues and debates that have arisen concerning the estimation of reliable change (e.g. how to accommodate practice effects) have progressed.
(5)
Recognizing that there are a range of ways that reliable change may be estimated, and the need to provide full details of the method used in any particular instance of its use.
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11
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Andersson G, Olsson E, Ringsgård E, Sandgren T, Viklund I, Andersson C, Hesselman Y, Johansson R, Nordgren LB, Bohman B. Individually tailored Internet-delivered cognitive-behavioral therapy for survivors of intimate partner violence: A randomized controlled pilot trial. Internet Interv 2021; 26:100453. [PMID: 34584851 PMCID: PMC8452796 DOI: 10.1016/j.invent.2021.100453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/24/2022] Open
Abstract
Intimate partner violence (IPV) is a serious public health concern worldwide and defined as behavior performed by spouses or other intimate partners that causes physical, sexual, or psychological harm. Internet-delivered cognitive-behavioral therapy (ICBT) may be particularly useful for survivors of IPV for several reasons, including barriers pertaining to limited community recourses and treatment availability, safety concerns, and issues of stigma, guilt and shame, which may prevent members of this population from seeking help via face-to-face interactions. However, Internet interventions are lacking. The primary aim of the present randomized controlled pilot trial was to explore the feasibility of ICBT as guided self-help individually tailored to the predominant symptomatology of PTSD or depression in survivors of IPV. A second aim was to conduct a preliminary evaluation exploring the short- and long-term effects of the treatment in comparison to a waitlist control condition. Results showed that the treatment was feasible. Attrition rate was low (9.4%), and participants were satisfied with treatment. However, treatment adherence was moderate in terms of completed modules (62.5%). Results of the preliminary evaluation of treatment effects showed large and statistically significant between-group effect sizes (Cohen's d = 0.86-1.08) on some measures of PTSD and depression at post assessment, favoring the treatment condition. However, there were no effects on other measures. At follow-up assessment, when the control condition had received delayed treatment, there were large and statistically significant within-group effect sizes (d = 0.96-1.48) on measures of PTSD, depression and anxiety, and small effects (d = 0.48) on a measure of quality of life. The results of the present pilot study are promising and warrant further research on ICBT for this population.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Elin Olsson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Emma Ringsgård
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Therese Sandgren
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Ida Viklund
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Catja Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Ylva Hesselman
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Robert Johansson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Lise Bergman Nordgren
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Benjamin Bohman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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12
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Fitzpatrick S, Wagner AC, Crenshaw AO, Varma S, Whitfield KM, Valela R, Di Bartolomeo AA, Fulham L, Martin-Newnham C, Mensah DH, Collins A, Landy MS, Morland L, Doss BD, Monson CM. Initial outcomes of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement. Internet Interv 2021; 25:100423. [PMID: 34401382 PMCID: PMC8350611 DOI: 10.1016/j.invent.2021.100423] [Citation(s) in RCA: 2] [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: 04/20/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/30/2022] Open
Abstract
Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction) is a guided, online couple intervention adapted from Cognitive-Behavioral Conjoint Therapy for posttraumatic stress disorder (PTSD). It was created to overcome a range of barriers to accessing evidence-based treatments for PTSD and the intimate relationship problems associated with it. This manuscript describes initial outcomes of the intervention in a series of 10 couples. Participants were military, veteran and first responders with probable PTSD and their intimate partners. Couples completed the program and measurements of PTSD, relationship satisfaction, and secondary outcomes at pre-, mid-, and post-intervention. Mean satisfaction for the program was high and it was completed by seven of ten couples. Participants with PTSD evidenced significant and large pre- to post-intervention effect size improvements in PTSD symptoms (g = 0.80) and perceived health (g = 1.13). They also exhibited non-significant but medium effect size pre- to post-intervention improvements in quality of life (g = 0.62), and depression (g = 0.53), and small effect size pre- to post-intervention improvements in argumentativeness (g = 0.43), anger (g = 0.31), and anxiety (g = 0.31). Partners reported significant and moderate pre- to post-intervention effect size improvements in relationship satisfaction (g = 0.68), and medium but not significant effect size improvements in accommodation of PTSD (g = 0.56). Results provide initial support for the feasibility, acceptability, and efficacy of Couple HOPES for improving PTSD and relationship satisfaction. However, more testing in larger samples, including with randomized controlled designs, is needed.
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Affiliation(s)
- Skye Fitzpatrick
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada,Corresponding author at: Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
| | - Anne C. Wagner
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada,Remedy, 703 Bloor St. W, #201, Toronto, ON M6G 1L5, Canada
| | - Alexander O. Crenshaw
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Sonya Varma
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Kristen M. Whitfield
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Robert Valela
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | | | - Lindsay Fulham
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Cait Martin-Newnham
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Desiree H. Mensah
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Alexis Collins
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Meredith S.H. Landy
- Remedy, 703 Bloor St. W, #201, Toronto, ON M6G 1L5, Canada,MindBeacon, 175 Bloor St. E., Toronto, ON M4W 358, Canada
| | - Leslie Morland
- VA San Diego Healthcare System, San Diego, CA, USA and University of California San Diego, La Jolla, 3350 La Jolla Village Dr., San Diego, CA 92161, United States of America
| | - Brian D. Doss
- University of Miami, 1320 S Dixie Hwy, Coral Gables, FL, 33146, United States of America
| | - Candice M. Monson
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
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13
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Weber Falk M, Salloum A, Alvariza A, Kreicbergs U, Sveen J. Outcomes of the grief and communication family support intervention on parent and child psychological health and communication. DEATH STUDIES 2020; 46:1750-1761. [PMID: 33272135 DOI: 10.1080/07481187.2020.1851816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Parents and children risk developing psychological health problems following the death of a partner/parent and may need professional support. This study used the reliable change criterion and clinically significant change to examine the outcomes of the Grief and Communication Family Support Intervention, comprising three family meetings with a family therapist, among 10 parents and 14 children, using pre-post outcome scores. The results provided preliminary evidence that the Grief and Communication Family Support Intervention may improve self-esteem and reduce anxiety in some parents and may improve communication and reduce internalizing and externalizing problems in some children.
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Affiliation(s)
- Megan Weber Falk
- Ersta Sköndal Bräcke University College, Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Alison Salloum
- University of South Florida College of Behavioral & Community Sciences, School of Social Work, Tampa, Florida, USA
| | - Anette Alvariza
- Ersta Sköndal Bräcke University College, Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Ersta Sköndal Bräcke University College, Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women and Child's Health, Karolinska Institute, Stockholm, Sweden
| | - Josefin Sveen
- Ersta Sköndal Bräcke University College, Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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14
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Kelly PJ, Deane FP, Davis EL, Hudson S, Robinson LD, Keane CA, Hatton EL, Larance B. Routine outcome measurement in specialist non-government alcohol and other drug treatment services: Establishing effectiveness indicators for the NADAbase. Drug Alcohol Rev 2020; 40:540-552. [PMID: 33155315 DOI: 10.1111/dar.13191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS The collection of routine outcome measurement (ROM) data provides an opportunity for service providers to conduct benchmarking to inform quality assurance practices. To conduct comparative benchmarking, it is important that services have access to comparative data. This paper aims to establish effectiveness indicators for ROM data collected within the alcohol and other drug (AOD) sector. DESIGN AND METHODS ROM data were collected by specialist non-government AOD treatment services within the Network of Alcohol and other Drugs Agencies online database (i.e. NADAbase). All participants were attending treatment within New South Wales, Australia (N = 21 572). Effectiveness indicators were calculated by using effect sizes, standard error of measurement, and rates of reliable and clinically significant change. The study focused on quality of life (EUROHIS Quality of Life Scale), psychological distress (Kessler-10) and substance dependence (Substance Dependence Scale). RESULTS Since 2010, 21 572 unique people have completed at least one NADAbase Client Outcome Measure. Amphetamines (36%) and alcohol (32%) were the most commonly reported primary substances of concern. Effectiveness indicators were established for the total sample, as well as for people attending residential rehabilitation (n = 8161) and community-based (n = 10 306) treatment services. Standard error of measurement was the least stringent effectiveness indicator (i.e. a higher proportion of people demonstrated improvement), while the clinically significant change was the most stringent approach. DISCUSSION AND CONCLUSIONS The study demonstrated the utility of the NADAbase to establish effectiveness indicators for benchmarking purposes. Recommendations are provided for the use of benchmarking to inform quality assurance activities in the sector.
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Affiliation(s)
- Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Esther L Davis
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Suzie Hudson
- Network of Alcohol and other Drug Agencies, Sydney, Australia
| | - Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Carol A Keane
- School of Psychology, University of Wollongong, Wollongong, Australia.,School of Health, Medical and Applied Science, Central Queensland University, Rockhampton, Australia
| | - Emma L Hatton
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
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15
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Sauer C, Maatouk I. [Development and Evaluation of an Acceptance and Commitment Therapy (ACT)-Based Group Intervention for Cancer Patients with Psychological Burden]. Psychother Psychosom Med Psychol 2020; 71:90-98. [PMID: 32634840 DOI: 10.1055/a-1174-0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Cancer is associated with many psychosocial stressors that lead to high psychological distress in over 50% of patients. About one third of patients make use of psycho-oncological services. Acceptance and Commitment Therapy (ACT), a transdiagnostic approach of the third wave of cognitive behavioral therapy, represents a promising approach for psycho-oncological interventions. However, the German-speaking area lacks a manualized ACT-based group intervention that is tested for feasibility and effectiveness. METHODS To bridge this gap, we developed and preliminarily tested an ACT group intervention in this one-arm monocentric pilot study. It targets psychological burdened cancer patients in all disease stages. During 8 sessions, the ACT core processes mindfulness, values and acceptance are worked out by means of metaphors and experience-oriented exercises. RESULTS Pre-Post-Data of our pilot study with n=25 patients indicate reductions in fear of progression, depression and psychological inflexibility, as well as an increase in psychological health-related quality of life and well-being. Regression analyses showed that changes in psychological flexibility predicted changes in all psychological outcome measures. The very high adherence underlines the feasibility of the intervention for the integrated outpatient clinic setting. DISCUSSION Our pilot study provides first evidences for the good feasibility and effectiveness of an ACT-based group intervention in the German-speaking area. These results on effectivness should be interpreted with caution due to the lack of an experimental control group. CONCLUSION Future studies should test the effectiveness of the intervention in randomized controlled trials (RCTs) with longer follow-up periods.
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Affiliation(s)
- Christina Sauer
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg
| | - Imad Maatouk
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg
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16
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Gutzweiler R, Schwarz D, In-Albon T. Transdiagnostische Behandlung emotionaler Störungen bei Jugendlichen mit dem Unified Protocol: Eine Fallstudie. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000508454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Angst- und depressive Störungen sind die häufigsten psychischen Störungen im Jugendalter und weisen untereinander eine hohe Komorbiditätsrate auf. Während kognitive Verhaltenstherapie (KVT) in der Behandlung von Angststörungen bei Jugendlichen wirksam ist, weist die Behandlung von depressiven Störungen nur moderate Wirksamkeit auf. Es liegen jedoch kaum Studien vor, die die Wirksamkeit der KVT in der Behandlung komorbid vorliegender Angst- und depressiver Störungen bei Jugendlichen untersuchen. Der transdiagnostische Ansatz des Unified Protocols (UP) für emotionale Störungen konnte seine Wirksamkeit im englischsprachigen Raum bereits im Jugend- und Erwachsenenalter nachweisen. Eine deutsche Übersetzung und Überprüfung des UP für Jugendliche steht bislang noch aus. <b><i>Falldarstellung:</i></b> In dieser Kasuistik wird eine 17-jährige Patientin vorgestellt, die die Kriterien einer sozialen Angststörung nach ICD-10 und DSM-5 erfüllt und zudem eine depressive Symptomatik aufweist. Nach einer umfassenden Diagnostik mithilfe eines strukturierten klinischen Interviews und Selbstberichtverfahrens wurden 17 Sitzungen KVT basierend auf dem UP für Adoleszente (UP-A) durchgeführt. Ziel der vorliegenden Fallbeschreibung ist die Vorstellung des Therapierationals und der Umsetzung des Manuals. Nach der Therapie erfüllte die Jugendliche die Kriterien der sozialen Angststörung nicht mehr, es zeigte sich zudem eine Abnahme der depressiven Symptomatik. <b><i>Schlussfolgerungen:</i></b> Die Fallvorstellung verweist auf die Umsetzbarkeit der deutschen Übersetzung des UP-A für die transdiagnostische Behandlung von Angst- und depressiven Störungen bei Jugendlichen. Eine randomisiert kontrollierte Studie zur Wirksamkeitsprüfung steht noch aus.
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17
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Vaganian L, Bussmann S, Gerlach AL, Kusch M, Labouvie H, Cwik JC. Critical consideration of assessment methods for clinically significant changes of mental distress after psycho-oncological interventions. Int J Methods Psychiatr Res 2020; 29:e1821. [PMID: 32090408 PMCID: PMC7301279 DOI: 10.1002/mpr.1821] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/19/2019] [Accepted: 01/29/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Considering the heterogeneity of cancer entities and the associated disease progression, personalized care of patients is increasingly emphasized in psycho-oncology. This individualization makes the use of measurements of individual clinically significant change important when studying the efficacy and effectiveness of psycho-oncological care. Two conceptualizations for the measurement of clinical significance are critically contrasted in this study: the Reliable Change Index (RCI) and the Minimal Important Difference (MID) method. METHODS In total, 2,121 cancer patients participated in the study and a subsample of 708 patients was reassessed about 4 months later. Psychological distress was measured using the Hospital Anxiety and Depression Scale. We evaluated two measures of clinical significance (RCI, MID) by comparing the respective numbers of improved, unimproved, and deteriorated patients. RESULTS Individually significant changes were observed with both methods; however, determined rates of improvement differed substantially: MID (66.67%) and RCI (48.23%). Most importantly, according to MID, 17.93% of patients were identified as being improved, although their respective improvements were not statistically significant and thus unreliable. CONCLUSIONS The benefits of RCI outweigh MID, and therefore, the RCI is recommended as a measure to assess change.
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Affiliation(s)
- Lusine Vaganian
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Sonja Bussmann
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Alexander L Gerlach
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Michael Kusch
- Department of Internal Medicine, Section: Clinical Psycho-Oncology, Working Group Psycho-Oncological Health Services Research, University Hospital of Cologne, Cologne, Germany
| | - Hildegard Labouvie
- Department of Internal Medicine, Section: Clinical Psycho-Oncology, Working Group Psycho-Oncological Health Services Research, University Hospital of Cologne, Cologne, Germany
| | - Jan C Cwik
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
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18
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Hawthorne SCC, Williams-Wengerd A. 'Effective' at What? On Effective Intervention in Serious Mental Illness. HEALTH CARE ANALYSIS 2020; 27:289-308. [PMID: 30895412 DOI: 10.1007/s10728-019-00367-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The term "effective," on its own, is honorific but vague. Interventions against serious mental illness may be "effective" at goals as diverse as reducing "apparent sadness" or providing housing. Underexamined use of "effective" and other success terms often obfuscates differences and incompatibilities in interventions, degrees of effectiveness, key omissions in effectiveness standards, and values involved in determining what counts as "effective." Yet vague use of such success terms is common in the research, clinical, and policy realms, with consequences that negatively affect the care offered to individuals experiencing serious mental illness. A pragmatist-oriented solution to these problems suggests that when people use success terms, they need to explain and defend the goals and supporting values embedded in the terms, asking and answering the questions, "Effective at what? For whom? How effective? And why that goal?" Practical and epistemic standards for effectiveness will likely remain plural for good reasons, but each standard should be well explained and well justified.
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Affiliation(s)
- Susan C C Hawthorne
- Philosophy Department, St. Catherine University, 2004 Randolph Ave, St. Paul, MN, 55105, USA.
| | - Anne Williams-Wengerd
- Psychology Department, St. Catherine University, 2004 Randolph Ave, St. Paul, MN, 55105, USA
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19
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Factors influencing the success of exposure therapy for specific phobia: A systematic review. Neurosci Biobehav Rev 2020; 108:796-820. [DOI: 10.1016/j.neubiorev.2019.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 11/24/2022]
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20
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de Beurs E, Carlier IVE, van Hemert AM. Approaches to denote treatment outcome: Clinical significance and clinical global impression compared. Int J Methods Psychiatr Res 2019; 28:e1797. [PMID: 31597212 PMCID: PMC7649961 DOI: 10.1002/mpr.1797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/18/2019] [Accepted: 07/02/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into clinically relevant categories, such as recovery and reliable improvement. We assessed the convergent validity of the Jacobson-Truax (JT) approach, using T-score based cutoff values, with ratings by an independent evaluator. METHODS Pretest and retest scores on the Brief Symptom Inventory (BSI) and clinical global impression improvement (CGI-I) ratings were collected repeatedly through routine outcome monitoring from 5,900 outpatients with common mental disorders. Data were collected in everyday practice in a large mental health care provider. RESULTS Continuous pretest-to-retest BSI change scores had a stronger association with CGI-I than the categorical variable based on JT. However, JT categorization and improvement according to CGI converged substantially with association indices (Somers' D) ranging from D = .50 to .56. Discordance was predominantly due to a more positive outcome according to JT than on CGI-I ratings. CONCLUSION Converting continuous outcome variables into clinically meaningful categories comes at the price of somewhat diminished concurrent validity with CGI-I. Nevertheless, support was found for the proposed threshold values for reliable change and recovery, and the outcome denoted in these terms corresponded with CGI improvement for most patients.
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Affiliation(s)
- Edwin de Beurs
- Section Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Ingrid V E Carlier
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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21
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Assessing the clinical significance of treatment outcomes for distressing voices in routine clinical practice. Clin Psychol Psychother 2019; 27:79-86. [DOI: 10.1002/cpp.2410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 11/07/2022]
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22
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Stayton LE, Martin CE, Pease JL, Chard KM. Changes in suicidal ideation following cognitive processing therapy in a VA residential treatment program. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1630230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Laura E. Stayton
- Trauma Recovery Center, Cincinnati VA Medical Center, Cincinnati, Ohio
| | - Colleen E. Martin
- Trauma Recovery Center, Cincinnati VA Medical Center, Cincinnati, Ohio
| | - James L. Pease
- Trauma Recovery Center, Cincinnati VA Medical Center, Cincinnati, Ohio
| | - Kathleen M. Chard
- Trauma Recovery Center, Cincinnati VA Medical Center, Cincinnati, Ohio
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
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23
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Schuster R, Kalthoff I, Walther A, Köhldorfer L, Partinger E, Berger T, Laireiter AR. Effects, Adherence, and Therapists' Perceptions of Web- and Mobile-Supported Group Therapy for Depression: Mixed-Methods Study. J Med Internet Res 2019; 21:e11860. [PMID: 31066700 PMCID: PMC6533044 DOI: 10.2196/11860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/10/2018] [Accepted: 10/27/2018] [Indexed: 02/07/2023] Open
Abstract
Background Blended group therapy (bGT) has been investigated a several times for anxiety and depression, but information on patients’ adherence to and therapists’ perception of the novel format is nonexistent. Furthermore, many studies investigated mainly female and highly educated populations, limiting the validity of previous findings. Objective This study aimed to reduce the gaps and limitations of the previous findings by evaluating an integrated internet- and mobile-supported bGT format. Methods A total of 27 patients diagnosed with major depression (14/27, 52% female and 7/27, 25.9% compulsory education) participated in a 7-week treatment at a university outpatient clinic. Furthermore, 8 novice therapists participated in semistructured interviews and a subsequent cross-validation survey. Results Primary symptom reduction was high (d=1.31 to 1.51) and remained stable for the follow-up period. Therapists identified advantages (eg, patient engagement, treatment intensification, and improved therapeutic relation) and disadvantages (eg, increased workload, data issues, and undesired effects) of bGT. The required online guidance time was 10.3 min per patient and week, including guidance on exercises (67% or 6.9 min) and intimate communication (33% or 3.4 min). Concerning patients’ adherence to bGT, tracked completion of all Web-based and mobile tasks was high and comparable with group attendance. Conclusions Results suggest high feasibility of bGT in a gender-balanced, moderately educated sample. bGT provides group therapists with tools for individual care, resulting in an optimization of the therapy process, and high completion rates of the implemented bGT elements. The limited work experience of the involved therapists restricts the study findings, and potential drawbacks need to be regarded in the development of future bGT interventions.
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Affiliation(s)
- Raphael Schuster
- Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Inanna Kalthoff
- Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Alexandra Walther
- Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Lena Köhldorfer
- Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Edith Partinger
- Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Berne, Berne, Switzerland
| | - Anton-Rupert Laireiter
- Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria.,Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Vienna, Austria
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De Smet MM, Meganck R, Van Nieuwenhove K, Truijens FL, Desmet M. No Change? A Grounded Theory Analysis of Depressed Patients' Perspectives on Non-improvement in Psychotherapy. Front Psychol 2019; 10:588. [PMID: 30971973 PMCID: PMC6443830 DOI: 10.3389/fpsyg.2019.00588] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/01/2019] [Indexed: 11/13/2022] Open
Abstract
Aim: Understanding the effects of psychotherapy is a crucial concern for both research and clinical practice, especially when outcome tends to be negative. Yet, while outcome is predominantly evaluated by means of quantitative pre-post outcome questionnaires, it remains unclear what this actually means for patients in their daily lives. To explore this meaning, it is imperative to combine treatment evaluation with quantitative and qualitative outcome measures. This study investigates the phenomenon of non-improvement in psychotherapy, by complementing quantitative pre-post outcome scores that indicate no reliable change in depression symptoms with a qualitative inquiry of patients' perspectives. Methods: The study took place in the context of a Randomised Controlled Trial evaluating time-limited psychodynamic and cognitive behavioral therapy for major depression. A mixed methods study was conducted including patients' pre-post outcome scores on the BDI-II-NL and post treatment Client Change Interviews. Nineteen patients whose data showed no reliable change in depression symptoms were selected. A grounded theory analysis was conducted on the transcripts of patients' interviews. Findings: From the patients' perspective, non-improvement can be understood as being stuck between knowing versus doing, resulting in a stalemate. Positive changes (mental stability, personal strength, and insight) were stimulated by therapy offering moments of self-reflection and guidance, the benevolent therapist approach and the context as important motivations. Remaining issues (ambition to change but inability to do so) were attributed to the therapy hitting its limits, patients' resistance and impossibility and the context as a source of distress. "No change" in outcome scores therefore seems to involve a "partial change" when considering the patients' perspectives. Conclusion: The study shows the value of integrating qualitative first-person analyses into standard quantitative outcome evaluation and particularly for understanding the phenomenon of non-improvement. It argues for more multi-method and multi-perspective research to gain a better understanding of (negative) outcome and treatment effects. Implications for both research and practice are discussed.
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Affiliation(s)
- Melissa Miléna De Smet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium.,Fonds Wetenschappelijk Onderzoek, Brussels, Belgium
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | | | - Femke L Truijens
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
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25
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Truijens FL, Cornelis S, Desmet M, De Smet MM, Meganck R. Validity Beyond Measurement: Why Psychometric Validity Is Insufficient for Valid Psychotherapy Research. Front Psychol 2019; 10:532. [PMID: 30915008 PMCID: PMC6423000 DOI: 10.3389/fpsyg.2019.00532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 02/22/2019] [Indexed: 11/17/2022] Open
Abstract
In psychotherapy research, "validity" is canonically understood as the capacity of a test to measure what is purported to measure. However, we argue that this psychometric understanding of validity prohibits working researchers from considering the validity of their research. Psychotherapy researchers often use measures with a different epistemic goal than test developers intended, for example when a depression symptom measure is used to indicate "treatment success" (cf. outcome measurement for evidence-based treatment). However, the validity of a measure does not cover the validity of its use as operationalization of another target concept within a research procedure, nor the validity of its function toward an epistemic goal. In this paper, we discuss the importance of considering validity of the epistemic process beyond the validity of measures per se, based on an empirical case example from our psychotherapy study ("SCS", Cornelis et al., 2017). We discuss why the psychometric understanding of validity is insufficient in covering epistemic validity, and we evaluate to what extent the available terminology regarding validity of research is sufficient for working researchers to accurately consider the validity of their overall epistemic process. As psychotherapy research is meant to offer a sound evidence-base for clinical practice, we argue that it is vital that psychotherapy researchers are able to discuss the validity of the epistemic choices made to serve the clinical goal.
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Affiliation(s)
- Femke L. Truijens
- Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
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26
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Orkibi H, Feniger-Schaal R. Integrative systematic review of psychodrama psychotherapy research: Trends and methodological implications. PLoS One 2019; 14:e0212575. [PMID: 30779787 PMCID: PMC6380607 DOI: 10.1371/journal.pone.0212575] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/05/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Psychodrama is an experiential psychotherapy in which guided role-play is used to gain insights and work on personal and interpersonal problems and possible solutions. Despite the wealth of literature describing clinical work, psychodrama intervention research is relatively scarce compared to other psychotherapies and psychological interventions. OBJECTIVE For this reason we implemented the integrative approach to systematic review that authorizes the combination of publications with diverse methodologies and all types of participants, interventions, comparisons, and outcomes. Our aim was to produce a comprehensive summary of psychodrama intervention research in the last decade that critically evaluates methodological issues to inform future studies. METHODS We searched four major electronic databases (PsycINFO, PubMEd, Scopus by Elsevier, and Web of Science) for peer-reviewed articles on psychodrama interventions published in English between 1 January 2007 and 31 December 2017. The quality of qualitative and mixed methods studies was assessed on the basis of pre-established guidelines, and the risk of bias was assessed for all quantitative randomized control studies, consistent with the PRISMA protocol. FINDINGS The database search and a hand search resulted in 31 psychodrama intervention publications. Overall, these studies examined the effects of psychodrama on more than 20 different outcomes and most studies had adult clients. The next largest group was adolescents, whereas only two studies involved children. Thus psychodrama intervention research in the last decade suggests there are promising results in all methodologies, and highlights the need to enhance methodological as well as reporting quality and to theorize and examine modality-specific mechanisms that lead to therapeutic change. Recommendations to improve methodology, transparency, and specificity in reporting future psychodrama and other psychotherapy research are discussed.
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Affiliation(s)
- Hod Orkibi
- School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Rinat Feniger-Schaal
- School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Estrada E, Ferrer E, Pardo A. Statistics for Evaluating Pre-post Change: Relation Between Change in the Distribution Center and Change in the Individual Scores. Front Psychol 2019; 9:2696. [PMID: 30671008 PMCID: PMC6331475 DOI: 10.3389/fpsyg.2018.02696] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/14/2018] [Indexed: 11/19/2022] Open
Abstract
In a number of scientific fields, researchers need to assess whether a variable has changed between two time points. Average-based change statistics (ABC) such as Cohen's d or Hays' ω2 evaluate the change in the distributions' center, whereas Individual-based change statistics (IBC) such as the Standardized Individual Difference or the Reliable Change Index evaluate whether each case in the sample experienced a reliable change. Through an extensive simulation study we show that, contrary to what previous studies have speculated, ABC and IBC statistics are closely related. The relation can be assumed to be linear, and was found regardless of sample size, pre-post correlation, and shape of the scores' distribution, both in single group designs and in experimental designs with a control group. We encourage other researchers to use IBC statistics to evaluate their effect sizes because: (a) they allow the identification of cases that changed reliably; (b) they facilitate the interpretation and communication of results; and (c) they provide a straightforward evaluation of the magnitude of empirical effects while avoiding the problems of arbitrary general cutoffs.
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Affiliation(s)
- Eduardo Estrada
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Emilio Ferrer
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Antonio Pardo
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, Madrid, Spain
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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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Dahlberg A, Wetterberg E, Lundh LG, Sahlin H. Experiences of Change in Emotion Regulation Group Therapy. A Mixed-Methods Study of Six Patients. J Pers Oriented Res 2018; 4:15-28. [PMID: 33569129 PMCID: PMC7842622 DOI: 10.17505/jpor.2018.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Emotion Regulation Group Therapy (ERGT) is a treatment for non-suicidal self-injury (NSSI) that has recently been implemented in Sweden and evaluated in an open trial with 95 patients in 14 adult outpatient psychiatric clinics (Sahlin et al., 2017). The purpose of the present study was to explore in more detail six of these patients’ experiences of change in ERGT by means of a person-oriented mixed-methods design. Reliable change and clinical significance were calculated for each individual on measures of self-harm, depression, anxiety, stress, and emotion regulation. Semi-structured interviews were carried out, transcribed and analysed using thematic analysis. Both the quantitative and qualitative data on change suggested that the most consistent changes occurred on emotion regulation. The treatment sessions that were most appreciated were those that focused on emotion awareness and emotion regulation. The participants also expressed appreciation of what ERGT afforded in terms of belonging and sharing with others, and the sense of equality in the relationship to the therapist. Critical comments were expressed concerning some parts of the treatment, as for example not having access to an individual therapist. Among the limitations of the study are the small convenience sample, which does not allow for any generalizing conclusions, and that the interviews took place a considerable time (2-3 years) after the participation in ERGT.
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Affiliation(s)
- Anna Dahlberg
- Department of Psychology, Lund University, Lund, Sweden
| | | | | | - Hanna Sahlin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Maxwell A, Tsoutsoulis K, Menon Tarur Padinjareveettil A, Zivkovic F, Rogers JM. Longitudinal analysis of statistical and clinically significant psychosocial change following mental health rehabilitation. Disabil Rehabil 2018; 41:2927-2939. [PMID: 29978733 DOI: 10.1080/09638288.2018.1482505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: With appropriate mental health rehabilitation, schizophrenia is increasingly associated with reports of recovery and stability. However, there is little empirical evidence evaluating the efficacy of services delivering this care. This study evaluated the effectiveness of rehabilitation for improving psychosocial function in consumers with schizophrenia.Methods: An electronic database of standardized assessment instruments mandated and maintained by the health service was retrospectively reviewed to extract ratings of psychosocial function, daily living skills, and mood state from consecutive admissions to an inpatient rehabilitation service. Outcomes were compared at admission, discharge, and one-year follow-up to identify statistically significant change. Individual reliable and clinically significant change was also assessed by comparison with a normative group of clients functioning independently in the community.Results: From admission to discharge the rehabilitation group made statistically significant gains in psychosocial function and daily living skills. Improvements were reliable and clinically significant in one-quarter to one-third of individual consumers. Approximately half sustained their improvements at follow-up, although this represented only a small fraction of the overall cohort. Consumers not demonstrating gains exhibited psychometric floor effects at admission.Conclusions: Rehabilitation can produce statistically and clinically significant immediate improvement in psychosocial function for a sub-set of consumers with elevated scores at admission. The durability of any gains is less clear, and strategies promoting longer-term maintenance are encouraged. Furthermore, currently mandated outcome measures are confounded by issues of sensitivity and reporting compliance, and exploration of alternative instruments for assessing recovery is recommended.Implications for RehabilitationRoutinely collected standardized outcome measures can be used to investigate the effectiveness of mental health rehabilitationIn addition to statistical significance, the clinical significance of outcomes should be evaluated to identify change that is individually meaningfulCurrently mandated outcomes instruments do not adequately evaluate many individuals' recovery journeyMental health service evaluation and quality improvement processes would likely benefit from adoption of recovery-oriented measures.
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Affiliation(s)
- Anna Maxwell
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Katrina Tsoutsoulis
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Aparna Menon Tarur Padinjareveettil
- South Eastern Sydney Local Health District, Sydney, NSW, Australia.,School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - Frank Zivkovic
- South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Jeffrey M Rogers
- South Eastern Sydney Local Health District, Sydney, NSW, Australia
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Hall CB, Lundh LG. Brief Therapist-Guided Exposure Treatment of Panic Attacks: A Pilot Study. Behav Modif 2018; 43:564-586. [PMID: 29862830 DOI: 10.1177/0145445518776472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A three-session therapist-guided exposure treatment was tested in a consecutive series of eight primary health care patients suffering from panic attacks who specifically used distraction techniques as their primary safety behavior. The Panic Disorder Severity Scale Self-Report (PDSS-SR) was administered at baseline (1-3 weeks before the first session), and 1, 2, and 3 weeks after treatment. Weekly ratings on the Body Sensations Questionnaire (BSQ) and the Agoraphobic Cognitions Questionnaire (ACQ) during treatment were undertaken to explore when reliable change took place on these measures. The results showed a large within-group effect size on PDSS-SR ( d = 1.63); six of the eight patients were classified as responders, and four of them showed remission. Large effect sizes ( ds between 1.17 and 3.00) were seen also on BSQ and ACQ, as well as on agoraphobic avoidance, general level of anxiety, and depression. The results on BSQ and ACQ suggest that the fear of body sensations in most cases was reduced before a change occurred in agoraphobic cognitions. These results indicate that a brief three-session exposure-based treatment may be sufficient for this subgroup of panic patients. The findings need to be replicated under controlled conditions with larger samples and different therapists before more firm conclusions can be drawn. Future research should also focus on the relevance of dividing patients into subgroups based on type of safety behavior.
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Schuster R, Fichtenbauer I, Sparr VM, Berger T, Laireiter AR. Feasibility of a blended group treatment (bGT) for major depression: uncontrolled interventional study in a university setting. BMJ Open 2018; 8:e018412. [PMID: 29530905 PMCID: PMC5857649 DOI: 10.1136/bmjopen-2017-018412] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study investigated the feasibility of a novel blended (face-to-face and computer-based) group intervention for the reduction of depressive symptoms in major depression. DESIGN Patient-centred uncontrolled interventional study. SETTING University setting in a general community sample. A multimodal recruitment strategy (public health centres and public areas) was applied. PARTICIPANTS Based on independent interviews, 26 participants, diagnosed with major depressive disorder (81% female; 23% comorbidity >1 and 23% comorbidity >2), entered treatment. INTERVENTION Acceptance and mindfulness based, as well as self-management and resource-oriented psychotherapy principles served as the theoretical basis for the low-threshold intervention. The blended format included face-to-face sessions, complemented with multimedia presentations and a platform featuring videos, online work sheets, an unguided group chat and remote therapist-patient communication. MAIN OUTCOME MEASURES The Center for Epidemiological Studies-Depression scale and the 12-item General Health Questionnaire. RESULTS Large to very large within group effect sizes were found on self-reported depression (F(2, 46.37)=25.69, p<0.001; d=1.80), general health (F(2,46.73)=11.47, p<0.001; d=1.32), personal resources (F(2,43.36)=21.17, p<0.001; d=0.90) and mindfulness (F(2,46.22)=9.40, p<0.001; d=1.12) after a follow-up period of 3 months. Treatment satisfaction was high, and 69% ranked computer and multimedia use as a therapeutic factor. Furthermore, participants described treatment intensification as important advantage of the blended format. Half of the patients (48%) would have preferred more time for personal exchange. CONCLUSION The investigated blended group format seems feasible for the reduction of depressive symptoms in major depression. The development of blended interventions can benefit from assuring that highly structured treatments actually meet patients' needs. As a next step, the intervention should be tested in comparative trials in routine care. TRIAL REGISTRATION NUMBER DRKS00010894; Pre-results.
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Affiliation(s)
- Raphael Schuster
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Isabelle Fichtenbauer
- Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Wien, Austria
| | - Verena Maria Sparr
- Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Wien, Austria
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anton-Rupert Laireiter
- Department of Psychology, University of Salzburg, Salzburg, Austria
- Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Wien, Austria
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Gomez Penedo JM, Constantino MJ, Coyne AE, Bernecker SL, Smith-Hansen L. Patient baseline interpersonal problems as moderators of outcome in two psychotherapies for bulimia nervosa. Psychother Res 2018; 29:799-811. [PMID: 29347888 DOI: 10.1080/10503307.2018.1425931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objective: We tested an aptitude by treatment interaction; namely, whether patients' baseline interpersonal problems moderated the comparative efficacy of cognitive-behavioral therapy (CBT) vs. interpersonal psychotherapy (IPT) for bulimia nervosa (BN). Method: Data derived from a randomized-controlled trial. Patients reported on their interpersonal problems at baseline; purge frequency at baseline, midtreatment, and posttreatment; and global eating disorder severity at baseline and posttreatment. We estimated the rate of change in purge frequency across therapy, and the likelihood of attaining clinically meaningful improvement (recovery) in global eating disorder severity by posttreatment. We then tested the interpersonal problem by treatment interactions as predictors of both outcomes. Results: Patients with more baseline overly communal/friendly problems showed steeper reduction in likelihood of purging when treated with CBT vs. IPT. Patients with more problems of being under communal/cold had similar reductions in likelihood of purging across both treatments. Patients with more baseline problems of being overly agentic were more likely to recover when treated with IPT vs. CBT, whereas patients with more problems of being under agentic were more likely to recover when treated with CBT vs. IPT. Conclusions: Interpersonal problems related to communion and agency may inform treatment fit among two empirically supported therapies for BN.
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Affiliation(s)
| | - Michael J Constantino
- b Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA
| | - Alice E Coyne
- b Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA
| | - Samantha L Bernecker
- b Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA.,d Present address: Department of Psychology , Harvard University , Cambridge , MA , USA
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Sembill A, Vocks S, Kosfelder J, Schöttke H. The phase model of psychotherapy outcome: Domain-specific trajectories of change in outpatient treatment. Psychother Res 2017; 29:541-552. [DOI: 10.1080/10503307.2017.1405170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Anja Sembill
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Silja Vocks
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Joachim Kosfelder
- Faculty of Social Sciences and Cultural Studies, Psychology, University of Applied Sciences, Düsseldorf, Germany
| | - Henning Schöttke
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
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Bantjes J, Hunt X, Tomlinson M, Smit A. A case study of lessons learnt from implementing a routine outcome monitoring system for psychotherapy in a South African community clinic. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1177/0081246317720853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Monitoring outcomes in psychotherapy is important for advancing research into empirically supported treatments, collecting data to inform practice-based evidence and for monitoring patient treatment responses during routine care. We implemented two routine outcome monitoring measures in a community psychology clinic in South Africa, namely, the Outcome Rating Scale and Kessler Psychological Distress Scale. In this article, we adopt a case study methodology to describe and critically reflect on the implementation process and evaluate the utility of the outcome data collected during the first year of implementation. Our findings suggest that the measures have some utility but that there were significant problems with implementation. We found that Outcome Rating Scale and Kessler Psychological Distress Scale scores correlated in the expected direction; however, Outcome Rating Scale intake scores for the present population were at odds with the measure’s norms. The findings highlight the care that needs to be taken to change routine clinical practice when outcome measures are implemented in local settings and the need for research to validate the use of these ROM measures in South African clinical settings.
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Affiliation(s)
- Jason Bantjes
- Psychology Department, Stellenbosch University, South Africa
| | - Xanthe Hunt
- Psychology Department, Stellenbosch University, South Africa
| | - Mark Tomlinson
- Psychology Department, Stellenbosch University, South Africa
| | - Anja Smit
- Psychology Department, Stellenbosch University, South Africa
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Watson JC, Saedi Chekan S, McMullen E. Emotion-focused psychotherapy for GAD: individual case comparison of a good and poor outcome case. PERSON-CENTERED & EXPERIENTIAL PSYCHOTHERAPIES 2017. [DOI: 10.1080/14779757.2017.1330707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jeanne C Watson
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Sepideh Saedi Chekan
- Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Evelyn McMullen
- Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
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Bowen MM, Lambert MJ, Berkeljon A, Orr TE, Berrett M, Simon W. Effects of feedback-assisted treatment on post-treatment outcome for eating disordered inpatients: A follow-up study. COGENT PSYCHOLOGY 2016. [DOI: 10.1080/23311908.2016.1191119] [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] Open
Affiliation(s)
- Megan M. Bowen
- Psychology Department, Brigham Young University, Provo, UT 84602, USA
| | | | - Arjan Berkeljon
- Psychology Department, Brigham Young University, Provo, UT 84602, USA
| | - Tyler E. Orr
- Psychology Department, Brigham Young University, Provo, UT 84602, USA
| | | | - Witold Simon
- Psychology Department, Brigham Young University, Provo, UT 84602, USA
- Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
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39
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Hjeltnes A, Molde H, Schanche E, Vøllestad J, Lillebostad Svendsen J, Moltu C, Binder PE. An open trial of mindfulness-based stress reduction for young adults with social anxiety disorder. Scand J Psychol 2016; 58:80-90. [DOI: 10.1111/sjop.12342] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 10/02/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Aslak Hjeltnes
- Department of Clinical Psychology; University of Bergen; Bergen Norway
| | - Helge Molde
- Department of Clinical Psychology; University of Bergen; Bergen Norway
| | | | - Jon Vøllestad
- Department of Clinical Psychology; University of Bergen; Bergen Norway
- Solli District Psychiatric Centre (DPS); Bergen Norway
| | | | - Christian Moltu
- Department of Clinical Psychology; University of Bergen; Bergen Norway
- District General Hospital of Førde; Førde Norway
| | - Per-Einar Binder
- Department of Clinical Psychology; University of Bergen; Bergen Norway
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40
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Ivanova E, Lindner P, Ly KH, Dahlin M, Vernmark K, Andersson G, Carlbring P. Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: A randomized controlled trial. J Anxiety Disord 2016; 44:27-35. [PMID: 27721123 DOI: 10.1016/j.janxdis.2016.09.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 08/14/2016] [Accepted: 09/29/2016] [Indexed: 12/20/2022]
Abstract
Acceptance and Commitment Therapy (ACT) can be effective in treating anxiety disorders, yet there has been no study on Internet-delivered ACT for social anxiety disorder (SAD) and panic disorder (PD), nor any study investigating whether therapist guidance is superior to unguided self-help when supplemented with a smartphone application. In the current trial, n=152 participants diagnosed with SAD and/or PD were randomized to therapist-guided or unguided treatment, or a waiting-list control group. Both treatment groups used an Internet-delivered ACT-based treatment program and a smartphone application. Outcome measures were self-rated general and social anxiety and panic symptoms. Treatment groups saw reduced general (d=0.39) and social anxiety (d=0.70), but not panic symptoms (d=0.05) compared to the waiting-list group, yet no differences in outcomes were observed between guided and unguided interventions. We conclude that Internet-delivered ACT is appropriate for treating SAD and potentially PD. Smartphone applications may partially compensate for lack of therapist support.
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Affiliation(s)
| | - Philip Lindner
- Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Kien Hoa Ly
- Department of Behavioral Science and Learning, Linköping University, Linköping, Sweden.
| | | | - Kristofer Vernmark
- Department of Behavioral Science and Learning, Linköping University, Linköping, Sweden; Psykologpartners, Linköping, Sweden.
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Behavioral Science and Learning, Linköping University, Linköping, Sweden.
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden.
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Bloomquist ML, Giovanelli A, Benton A, Piehler TF, Quevedo K, Oberstar J. Implementation and Evaluation of Evidence-Based Psychotherapeutic Practices for Youth in a Mental Health Organization. JOURNAL OF CHILD AND FAMILY STUDIES 2016; 25:3278-3292. [PMID: 30078979 PMCID: PMC6075715 DOI: 10.1007/s10826-016-0479-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The current initiative and program evaluation study is a demonstration of the research to practice process in youth-focused psychotherapy. We collaborated within a community-university partnership to create practice and research infrastructure in order to develop, implement, and evaluate two new models of service founded on evidence-based psychotherapeutic practice parameters. The two new service models incorporated validated interventions to address behavior problems in elementary age children, and depression in adolescents, which were delivered in separate but similarly run intensive outpatient programs within a mental health setting. We utilized a rigorous training, technical assistance, fidelity monitoring, and outcome measurement strategy to promote the integrity and quality of services provided. The resultant programs were delivered with acceptable to high fidelity and effects on youth and parenting measures collected during program and from pre to post showed a decrease in targeted problems in youth and positive benefits for families. This initiative and program evaluation adds to the accumulating research-to-practice literature in children's mental health.
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Affiliation(s)
- Michael L. Bloomquist
- Department of Psychiatry, University of Minnesota, F256/2B West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
- PrairieCare Medical Group, Minneapolis, MN, USA
| | - Alison Giovanelli
- Department of Psychiatry, University of Minnesota, F256/2B West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
| | - Anna Benton
- Department of Psychiatry, University of Minnesota, F256/2B West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
| | - Timothy F. Piehler
- Department of Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Avenue, Saint Paul, MN 55108, USA
| | - Karina Quevedo
- Department of Psychiatry, University of Minnesota, F256/2B West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
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Collins LM, Coles ME. Initial data on a 5-item measure of OCD symptom severity and change: The obsessive compulsive session change index (OCSCI). J Anxiety Disord 2016; 43:8-13. [PMID: 27467028 DOI: 10.1016/j.janxdis.2016.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 06/20/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
Repeated measurement of symptoms throughout treatment allows providers to assess individual patterns of symptom change. However, outside of a clinical trial, administration of lengthy measures at each session is unlikely. Therefore, in order to bridge the gap between clinical research and actual clinical practice we developed a brief self-report measure of obsessive compulsive symptoms that can be used at each session, the Obsessive Compulsive Session Change Index (OCSCI). The OCSCI assesses time spent on obsessions, time spent on compulsions, interference and distress related to obsessions and compulsions, and relative change in symptoms from the beginning of treatment. This paper reports initial psychometric properties of the OCSCI. Twenty-seven adults receiving exposure and ritual prevention for obsessive compulsive disorder (OCD) completed the OCSCI at each session. Results showed that the OCSCI had good internal consistency, and convergent and divergent validity. Specifically, the OCSCI had moderate to strong correlations with both self-reported and clinician rated OCD. Finally, the OCSCI was not as strongly correlated with depressive symptoms as it was with OCD symptoms. The findings presented herein suggest that the OCSCI can be useful as a measure of client progress throughout treatment.
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Affiliation(s)
- Lindsey M Collins
- Department of Psychology, Binghamton University, 4400 Vestal Pkwy E, Vestal, NY 13850, United States.
| | - Meredith E Coles
- Department of Psychology, Binghamton University, 4400 Vestal Pkwy E, Vestal, NY 13850, United States
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Diedrich A, Schlegl S, Greetfeld M, Fumi M, Voderholzer U. Intensive inpatient treatment for bulimia nervosa: Statistical and clinical significance of symptom changes. Psychother Res 2016; 28:297-312. [DOI: 10.1080/10503307.2016.1210834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Alice Diedrich
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany
| | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany
| | | | - Markus Fumi
- Schön Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Schön Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
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44
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Lilja JL, Zelleroth C, Axberg U, Norlander T. Mindfulness-based cognitive therapy is effective as relapse prevention for patients with recurrent depression in Scandinavian primary health care. Scand J Psychol 2016; 57:464-72. [DOI: 10.1111/sjop.12302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/28/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Josefine L. Lilja
- Department of Psychology; Gothenburg University; Göteborg Sweden
- Center for Research and Development; Evidens University College; Göteborg Sweden
- Närhälsan Health Clinic; Kållekärr Sweden
| | - Clara Zelleroth
- Center for Research and Development; Evidens University College; Göteborg Sweden
| | - Ulf Axberg
- Department of Psychology; Gothenburg University; Göteborg Sweden
| | - Torsten Norlander
- Center for Research and Development; Evidens University College; Göteborg Sweden
- Department of Clinical Neuroscience; Karolinska Institute; Solna Sweden
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Ronk FR, Hooke GR, Page AC. Validity of clinically significant change classifications yielded by Jacobson-Truax and Hageman-Arrindell methods. BMC Psychiatry 2016; 16:187. [PMID: 27267986 PMCID: PMC4895887 DOI: 10.1186/s12888-016-0895-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 05/31/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Reporting of the clinical significance of observed changes is recommended when publishing mental health treatment outcome studies and is increasingly used in routine outcomes monitoring systems. Since recovery rates vary with the method chosen, we investigated the validity of classifications of clinically significant change when the Jacobson-Truax method and the Hageman-Arrindell method were used. METHODS Of 718 inpatients who completed the Depression Anxiety Stress Scales (DASS-21) and Quality of Life Enjoyment and Satisfaction Questionnaire at admission and discharge to a psychiatric clinic, 355 were invited (and 119 agreed) to complete the questionnaires and the Recovery Assessment Scale six weeks post discharge. RESULTS Both the JT and HA methods showed comparably good validity when referenced against the other indices. Clinically significant change on the DASS-21 was related to a greater consumer-based sense of recovery, greater perceived quality of life, and fewer readmissions to hospital within 28 days of discharge. CONCLUSIONS Since there was found to be no advantage to using one method over another when recovery is of interest, the simpler JT method is recommended for routine usage.
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Affiliation(s)
- Fiona R Ronk
- School of Psychology, The University of Western Australia, 35 Stirling Hwy, Crawley, 6009, Australia
- Perth Clinic, Perth, Western Australia
| | - Geoffrey R Hooke
- School of Psychology, The University of Western Australia, 35 Stirling Hwy, Crawley, 6009, Australia
- Perth Clinic, Perth, Western Australia
| | - Andrew C Page
- School of Psychology, The University of Western Australia, 35 Stirling Hwy, Crawley, 6009, Australia.
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Hjeltnes A, Moltu C, Schanche E, Jansen Y, Binder PE. Both sides of the story: Exploring how improved and less-improved participants experience mindfulness-based stress reduction for social anxiety disorder. Psychother Res 2016; 28:106-122. [PMID: 27093373 DOI: 10.1080/10503307.2016.1169330] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE What works for whom in mindfulness-based group interventions for social anxiety disorder (SAD)? The present article compared the experiences of 14 participants in a clinical study of mindfulness-based stress reduction (MBSR) for young adults with SAD. METHODS A two-staged mixed methods design was used to identify the participants who reported the highest (n = 7) and lowest (n = 7) levels of symptomatic change on outcome measures after treatment, and analyze qualitative in-depth interviews to explore what they experienced as helpful and unhelpful during the MBSR program. The qualitative interviews were analyzed using a thematic analysis methodology. RESULTS We identified the global theme of (i) Discovering agency to change or not feeling empowered through the MBSR program, and four sub-themes: (ii) Forming an active commitment or feeling ambivalence toward learning mindfulness, (iii) Engaging with others or avoiding contact with the group, (iv) Using the mindfulness exercises to approach or resigning when facing unpleasant experiences, and (v) Using the course to break interpersonal patterns or remaining stuck in everyday life. CONCLUSIONS MBSR may be helpful for young adults with SAD, although it may be important to match clients to their preferred form of treatment.
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Affiliation(s)
- Aslak Hjeltnes
- a Department of Clinical Psychology , University of Bergen , Bergen , Norway
| | | | - Elisabeth Schanche
- a Department of Clinical Psychology , University of Bergen , Bergen , Norway
| | - Ylva Jansen
- a Department of Clinical Psychology , University of Bergen , Bergen , Norway
| | - Per-Einar Binder
- a Department of Clinical Psychology , University of Bergen , Bergen , Norway
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Beadnell B, Stafford PA, Crisafulli MA, Casey EA, Rosengren DB. Methods for Quantifying the Clinical Significance of Change During Intervention Program Participation. Eval Health Prof 2016; 39:435-459. [PMID: 26880527 DOI: 10.1177/0163278715622663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Assessing the practical or clinical significance (CS) of an intervention program's outcomes is useful in determining its effectiveness. The CS approach gives information beyond traditional analyses by quantifying the proportions of people who meaningfully improve and deteriorate. We link latent transition analyses (LTA) to the CS literature and use a case study to contrast it with the long-standing Jacobson and Truax (JT) approach. Data came from 2,717 individuals convicted of a substance-related offense who participated in an indicated prevention program Prime For Life® (PFL). We selected outcomes describing drinking beliefs and behavior. Both CS approaches categorized a majority of participants as improved (i.e., transitioning from baseline subgroups with risky behaviors and cognitions into posttest subgroups showing lower risk). Results demonstrate how the JT approach allows the assessment of improvements on individual outcomes, while the LTA provides more nuanced information about risk groupings. Selecting a CS approach depends on research goals, availability of normative data, and data considerations. JT is an appropriate method when evaluating single outcomes. In contrast, LTA is better when a multivariate description is desired, advanced missing data handling methods are needed, or outcomes are not normally distributed. Although infrequently done, evaluating CS provides useful information about program effectiveness.
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Affiliation(s)
| | | | | | - Erin A Casey
- University of Washington Tacoma, Tacoma, WA, USA
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Abstract
This paper serves as an introduction to the 25th anniversary issue of Psychotherapy research. It includes a consideration of the original aims of the journal in light of the most cited articles, various developments in research orientation and methodology, and most recent publications. It demonstrates both diversity and consistency in content over time, as well as the international reach of the journal.
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Affiliation(s)
- J Christopher Muran
- a Derner Institute of Advanced Psychological Studies , Adelphi University , Garden City , NY , USA
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Kontunen J, Timonen M, Muotka J, Liukkonen T. Is interpersonal counselling (IPC) sufficient treatment for depression in primary care patients? A pilot study comparing IPC and interpersonal psychotherapy (IPT). J Affect Disord 2016; 189:89-93. [PMID: 26432031 DOI: 10.1016/j.jad.2015.09.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/26/2015] [Accepted: 09/18/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychotherapeutic treatment is underused in primary care, where even short-term psychotherapy can be perceived as too lengthy and labour-intensive. We tested here for the first time the preliminary efficacy of seven sessions of interpersonal counselling (IPC) by comparison with sixteen sessions of interpersonal psychotherapy (IPT) in regular clinical settings. METHODS Patients seeking treatment for the first time who met the DSM-IV criteria for major depressive disorder (MDD, mild/moderate) were randomized to either IPC (n=20) or IPT (n=20). The efficacy of the treatments was assessed using the 34-item Clinical Outcomes in Routine Evaluation (CORE-OM) scale and the Beck Depression Inventory (BDI) scale. RESULTS 90% of the patients completed all the treatment sessions. IPC delivered by psychiatric nurses in primary care proved equally as effective as IPT delivered by psychotherapists/psychologists in secondary care. The pre-treatment to 12-month follow-up within-group effect sizes were large: 1.52 (CORE-OM) and 1.41 (BDI) in the IPC group and 1.58 (CORE-OM) and 1.40 (BDI) in the IPT group. At the 12-month follow-up 59% of the patients in the IPC group and 63% in the IPT group were classified as recovered on the CORE-OM scale, with corresponding remission rates of 61% for both groups on the BDI scale. LIMITATIONS The small sample size limited the power to detect differences between the groups and the naturalistic settings may have confounded the results. CONCLUSIONS This clinical trial suggests that IPC is an appropriate and even sufficient first-phase intervention for handling previously untreated mild to moderate depression in primary health care.
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Affiliation(s)
- Jarmo Kontunen
- Department of Psychology, University of Jyväskylä, Finland.
| | - Markku Timonen
- Institute of Health Sciences, University of Oulu, Finland
| | - Joona Muotka
- Department of Psychology, University of Jyväskylä, Finland
| | - Timo Liukkonen
- Department of Psychiatry, Savonlinna Central Hospital, and Institute of Health Sciences, University of Oulu, Finland
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Abstract
Cognitive behavioral therapy has demonstrated large effect sizes for the treatment of hypochondriasis. However, response and remission rates, which provide important additional information about clinically significant improvements, have seldom been reported. In the current study, rates of response and remission after cognitive therapy and exposure therapy were evaluated. The study was based on a randomized controlled trial that treated patients with hypochondriasis (N = 75). The primary outcome measure was a clinician-administered structured interview for hypochondriasis. At posttreatment, response was found for 72.0% and remission for 45.3% of the patients. At 12-month follow-up, the response rate was 68.0%, and the remission rate was 54.7%. No significant differences in the frequency of response/remission were found between the cognitive therapy and the exposure therapy groups. Patients' and therapists' perspectives of clinical improvement corresponded with remission rather than response rates. Improvement rates were compared with those of other mental disorders, and implications for the treatment of hypochondriasis were discussed.
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