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Kvestad CA, Holte IR, Reitan SK, Chiappa CS, Helle GK, Skjervold AE, Rosenlund AMA, Watne Ø, Brattland H, Helle J, Follestad T, Hara KW, Holgersen KH. Measuring the Effect of the Early assessment Team (MEET) for patients referred to outpatient mental health care: a study protocol for a randomised controlled trial. Trials 2024; 25:179. [PMID: 38468321 DOI: 10.1186/s13063-024-08028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/01/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Referrals to specialised mental health care (such as community mental health centres; CMHC) have increased over the last two decades. Patients often have multifaceted problems, which cannot only be solved by such care. Resources are limited, and triaging is challenging. A novel method which approaches patients early and individually upon referral to a CMHC-possibly with a brief intervention-is an Early assessment Team (EaT). In an EaT, two therapists meet the patient early in the process and seek to solve the present problem, often involving community services, primary health care, etc.; attention is paid to symptoms and functional strife, rather than diagnoses. This is in contrast to treatment as usual (TAU), where the patient (after being on a waiting list) meets one therapist, who focuses on history and situation to assign a diagnosis and eventually start a longitudinal treatment. The aim of this study is to describe and compare EaT and TAU regarding such outcomes as work and social adjustment, mental health, quality of life, use of health services, and patient satisfaction. The primary outcome is a change in perceived function from baseline to 12-month follow-up, measured by the Work and Social Adjustment Scale. METHOD Patients (18 years and above; n = 588) referred to outpatient health care at a CMHC are randomised to EaT or TAU. Measures (patient self-reports and clinician reports, patients' records, and register data) are collected at baseline, after the first and last meeting, and at 2, 4, 8, 12, and 24 months after inclusion. Some participants will be invited to participate in qualitative interviews. TRIAL DESIGN The study is a single-centre, non-blinded, RCT with two conditions involving a longitudinal and mixed design (quantitative and qualitative data). DISCUSSION This study will examine an intervention designed to determine early on which patients will benefit from parallel or other measures than assessment and treatment in CMHC and whether these will facilitate their recovery. Findings may potentially contribute to the development of the organisation of mental health services. TRIAL REGISTRATION ClinicalTrials.gov NCT05087446. Registered on 21 October 2021.
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Affiliation(s)
- Camilla Angelsen Kvestad
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Ingvild Rønneberg Holte
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solveig Klæbo Reitan
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Charlotte S Chiappa
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gunn Karin Helle
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne E Skjervold
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Marit A Rosenlund
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øyvind Watne
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Heidi Brattland
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jon Helle
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Turid Follestad
- Clinical Research Unit Central Norway, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karen Walseth Hara
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Trondheim, Norway
- Norwegian Labour and Welfare Administration Trøndelag, Trondheim, Norway
| | - Katrine Høyer Holgersen
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Scholl CC, Soares MC, do Nascimento E, Trettim JP, de Matos MB, Stigger RS, Pires AJ, Tabeleão VP, da Silva RA, Souza LDDM, Quevedo LDA, de Figueiredo VLM. Evidence of validity of the revised Helping Alliance Questionnaire based on the internal structure in a Brazilian clinical sample. Clin Psychol Psychother 2021; 29:622-630. [PMID: 34318979 DOI: 10.1002/cpp.2654] [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: 02/18/2021] [Revised: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 11/10/2022]
Abstract
The revised Helping Alliance Questionnaire (HAq-II) is among the most used instruments that measure therapeutic alliance. Despite its use in research, this instrument is not validated for the Brazilian population. The aim of this study was to explore the evidence of validity of the HAq-II based on the internal structure in a sample of Brazilian psychiatric patients. An ambulatory convenience sample of 204 patients with major depressive disorder (MDD) and 81 patients with obsessive-compulsive disorder (OCD) was randomized between two different types of treatment. The HAq-II was completed by patients (patient version) and by 33 therapists who performed the interventions (therapist version) between the second and third sessions. We used confirmatory factor analysis (CFA) to investigate two models: (1) a one-dimensional therapeutic alliance model and (2) a two-dimensional model considering the factors 'positive alliance' and 'negative alliance'. The internal consistency of the HAq-II was measured by Cronbach's alpha. To investigate discriminant validity, we used the t-test for independent samples, ANOVA and Pearson's correlation coefficient. The analysis showed that the best model of the instrument was one-dimensional. Cronbach's alpha for both versions displayed values above 0.89. The Brazilian version of the HAq-II presented properties similar to those found in the original version. However, studies related to the one-dimensional model with other samples are necessary.
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Affiliation(s)
- Carolina Coelho Scholl
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | - Mariana Carret Soares
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | | | - Jéssica Puchalski Trettim
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | - Mariana Bonati de Matos
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | - Rafaelle Stark Stigger
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | - Andressa Jacondino Pires
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | - Viviane Porto Tabeleão
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | - Ricardo Azevedo da Silva
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | | | - Luciana de Avila Quevedo
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
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Zimmermann D, Wampold BE, Rubel JA, Schwartz B, Poster K, Schilling VNLS, Deisenhofer AK, Hehlmann MI, Gómez Penedo JM, Lutz W. The influence of extra-therapeutic social support on the association between therapeutic bond and treatment outcome. Psychother Res 2020; 31:726-736. [PMID: 33252021 DOI: 10.1080/10503307.2020.1847344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Objective: Both good therapeutic bond as well as extra-therapeutic social support seem to enhance treatment outcomes. Some features of the therapeutic bond are similar to experiences in extra-therapeutic relationships (e.g., feelings of trust or belongingness). Patients with a lack of social support might benefit particularly from a good therapeutic bond, because a well-formed bond can partly substitute relationship needs. This study replicates former research (main effects of bond and social support) and investigates the hypothesized interaction between both constructs. Method: Data from 1206 adult patients receiving cognitive-behavioral outpatient therapy were analyzed. Patients rated early therapeutic bond, their impairment, as well as their social support. Multilevel regression analyses were applied to test for main effects and interactions between bond and social support predicting therapy outcome post treatment. Results: Consistent with prior research, both therapeutic bond and social support predicted therapy outcome. Among patients with high social support, the impact of the therapeutic bond was minimal, while patients with low social support benefited most from a good therapeutic bond. Conclusions: Results suggest that both the therapeutic bond and social support play a role in therapy outcomes and that good therapeutic bond quality might be especially important if a patient lacks social support.
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Affiliation(s)
- Dirk Zimmermann
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany
| | - Bruce E Wampold
- Modum Bad Research Institute, University of Wisconsin, Madison, WI, USA
| | | | - Brian Schwartz
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany
| | - Kaitlyn Poster
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany
| | - Viola N L S Schilling
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany
| | | | - Miriam I Hehlmann
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany
| | | | - Wolfgang Lutz
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany
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Schilling VNLS, Zimmermann D, Rubel JA, Boyle KS, Lutz W. Why do patients go off track? Examining potential influencing factors for being at risk of psychotherapy treatment failure. Qual Life Res 2020; 30:3287-3298. [PMID: 33089473 PMCID: PMC8528765 DOI: 10.1007/s11136-020-02664-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Routine outcome monitoring can support clinicians to detect patients who deteriorate [not-on-track (NOT)] early in psychotherapy. Implemented Clinical Support Tools can direct clinicians' attention towards potential obstacles to a positive treatment outcome and provide suggestions for suitable interventions. However, few studies have compared NOT patients to patients showing expected progress [on-track (OT)] regarding such obstacles. This study aimed to identify domains that have predictive value for NOT trajectories and to compare OT and NOT patients regarding these domains and the items of the underlying scales. METHODS During treatment, 413 outpatients filled in the Hopkins-Symptom-Checklist-11 (depressive and anxious symptom distress) before every therapy session as a routine outcome measure. Further, the Assessment for Signal Clients, Affective Style Questionnaire, and Outcome Questionnaire-30 were applied every fifth session. These questionnaires measure the following domains, which were investigated as potential obstacles to treatment success: risk/suicidality, therapeutic alliance, motivation, social support and life events, as well as emotion regulation. Two groups (OT and NOT patients) were formed by defining a cut-off (failure boundary) as the 90% confidence interval (upper bound) of the respective patients' expected recovery curves. In order to differentiate group membership based on the respective problem areas, multilevel logistic regression analyses were performed. Further, OT and NOT patients were compared with regard to the domains' and items' cut-offs by performing Pearson chi-square tests and independent samples t-tests. RESULTS The life events and motivation scale as well as the risk/suicidality scale proved to be significant predictors of being not-on-track. NOT patients also crossed the cut-off significantly more often on the domains risk/suicidality, social support, and life events. For both OT and NOT patients, the emotion regulation domain's cut-off was most commonly exceeded. CONCLUSION Life events, motivation, and risk/suicidality seem to be directly linked to treatment failure and should be further investigated for the use in clinical support tools.
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Affiliation(s)
- Viola N L S Schilling
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Trier, 54286, Trier, Germany.
| | - Dirk Zimmermann
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Trier, 54286, Trier, Germany
| | | | - Kaitlyn S Boyle
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Trier, 54286, Trier, Germany
| | - Wolfgang Lutz
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Trier, 54286, Trier, Germany
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5
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Probst T, Kleinstäuber M, Lambert MJ, Tritt K, Pieh C, Loew TH, Dahlbender RW, Delgadillo J. Why are some cases not on track? An item analysis of the Assessment for Signal Cases during inpatient psychotherapy. Clin Psychol Psychother 2020; 27:559-566. [PMID: 32131148 PMCID: PMC7496290 DOI: 10.1002/cpp.2441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 01/02/2020] [Accepted: 03/03/2020] [Indexed: 11/25/2022]
Abstract
Within the Routine Outcome Monitoring system “OQ‐Analyst,” the questionnaire “Assessment for Signal Cases” (ASC) supports therapists in detecting potential reasons for not‐on‐track trajectories. Factor analysis and a machine learning algorithm (LASSO with 10‐fold cross‐validation) were applied, and potential predictors of not‐on‐track classifications were tested using logistic multilevel modeling methods. The factor analysis revealed a shortened (30 items) version of the ASC with good internal consistency (α = 0.72–0.89) and excellent predictive value (area under the curve = 0.98; positive predictive value = 0.95; negative predictive value = 0.94). Item‐level analyses showed that interpersonal problems captured by specific ASC items (not feeling able to speak about problems with family members; feeling rejected or betrayed) are the most important predictors of not‐on‐track trajectories. It should be considered that our results are based on analyses of ASC items only. Our findings need to be replicated in future studies including other potential predictors of not‐on‐track trajectories (e.g., changes in medication, specific therapeutic techniques, or treatment adherence), which were not measured this study.
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Affiliation(s)
- Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems an der Donau, Austria
| | - Maria Kleinstäuber
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Karin Tritt
- Department of Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems an der Donau, Austria
| | - Thomas H Loew
- Department of Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Reiner W Dahlbender
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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6
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Odyniec P, Probst T, Göllner R, Margraf J, Willutzki U. An exploratory study of patients' sudden losses during outpatient CBT and therapists' experience of difficulties. J Clin Psychol 2019; 75:1790-1809. [PMID: 31254365 DOI: 10.1002/jclp.22828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Patients' sudden deterioration in symptomatology, also called sudden losses, is a rarely explored phenomenon. METHOD Psychological distress of 1,763 patients treated by 140 therapists was monitored after every therapy session. Patient-reported outcome measures and patients' therapy satisfaction was assessed. Therapists rated their experience of difficulties for every patient repeatedly over the course of therapy. RESULTS More than one-quarter of patients (26.5%) experienced at least one sudden loss during therapy. Patients with sudden losses did not differ significantly in psychotherapy outcome and therapy satisfaction from patients without sudden shifts. Therapists did not experience professional self-doubt more often when working with sudden loss patients. CONCLUSION Sudden losses were not necessarily harmful for the outcome of psychotherapy and patients' global therapy satisfaction. The results suggest that sudden losses can be compensated over the course of treatment.
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Affiliation(s)
- Patrizia Odyniec
- Department of Psychology and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
| | - Richard Göllner
- Hector Research Institute of Education Sciences and Psychology, University of Tübingen, Tübingen, Germany
| | - Jürgen Margraf
- Department of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Ulrike Willutzki
- Department of Psychology and Psychotherapy, University Witten/Herdecke, Witten, Germany
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7
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Lewis CC, Boyd M, Puspitasari A, Navarro E, Howard J, Kassab H, Hoffman M, Scott K, Lyon A, Douglas S, Simon G, Kroenke K. Implementing Measurement-Based Care in Behavioral Health: A Review. JAMA Psychiatry 2018; 76:324-335. [PMID: 30566197 PMCID: PMC6584602 DOI: 10.1001/jamapsychiatry.2018.3329] [Citation(s) in RCA: 254] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Measurement-based care (MBC) is the systematic evaluation of patient symptoms before or during an encounter to inform behavioral health treatment. Despite MBC's demonstrated ability to enhance usual care by expediting improvements and rapidly detecting patients whose health would otherwise deteriorate, it is underused, with typically less than 20% of behavioral health practitioners integrating it into their practice. This narrative review addresses definitional issues, offers a concrete and evaluable operationalization of MBC fidelity, and summarizes the evidence base and utility of MBC. It also synthesizes the extant literature's characterization of barriers to and strategies for supporting MBC implementation, sustainment, and scale-up. OBSERVATIONS Barriers to implementing MBC occur at multiple levels: patient (eg, concerns about confidentiality breach), practitioner (eg, beliefs that measures are no better than clinical judgment), organization (eg, no resources for training), and system (eg, competing requirements). Implementation science-the study of methods to integrate evidence-based practices such as MBC into routine care-offers strategies to address barriers. These strategies include using measurement feedback systems, leveraging local champions, forming learning collaboratives, training leadership, improving expert consultation with clinical staff, and generating incentives. CONCLUSIONS AND RELEVANCE This narrative review, informed by implementation science, offers a 10-point research agenda to improve the integration of MBC into clinical practice: (1) harmonize terminology and specify MBC's core components; (2) develop criterion standard methods for monitoring fidelity and reporting quality of implementation; (3) develop algorithms for MBC to guide psychotherapy; (4) test putative mechanisms of change, particularly for psychotherapy; (5) develop brief and psychometrically strong measures for use in combination; (6) assess the critical timing of administration needed to optimize patient outcomes; (7) streamline measurement feedback systems to include only key ingredients and enhance electronic health record interoperability; (8) identify discrete strategies to support implementation; (9) make evidence-based policy decisions; and (10) align reimbursement structures.
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Affiliation(s)
- Cara C. Lewis
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | - Meredith Boyd
- Department of Psychology, UCLA (University of California, Los
Angeles)
| | - Ajeng Puspitasari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester,
Minnesota
| | - Elena Navarro
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | - Jacqueline Howard
- Department of Psychological and Brain Sciences, Indiana University,
Bloomington
| | | | - Mira Hoffman
- Department of Psychology, West Virginia University,
Morgantown
| | - Kelli Scott
- School of Public Health, Brown University, Providence, Rhode
Island
| | - Aaron Lyon
- Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Peabody
College, Vanderbilt University, Nashville, Tennessee
| | - Greg Simon
- Kaiser Permanente Washington Health Research Institute,
Seattle
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Probst T, Weise C, Andersson G, Kleinstäuber M. Differences in baseline and process variables between non-responders and responders in Internet-based cognitive behavior therapy for chronic tinnitus. Cogn Behav Ther 2018; 48:52-64. [PMID: 29873278 DOI: 10.1080/16506073.2018.1476582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Although Internet-based cognitive behavior therapy (iCBT) is an effective treatment for chronic tinnitus, several patients do not improve. In the current study, baseline and process variables were compared between non-responders and responders. Data from patients participating in two randomized controlled trials on iCBT for chronic tinnitus were re-analyzed. Based on the literature, a pre-post difference on the "Tinnitus Handicap Inventory" (THI) of less than seven points improvement was used to operationalize non-response. Associations between non-response and baseline variables (age, gender, and questionnaire scores), patient progress (THI), the process of the therapeutic alliance ("Working Alliance Inventory-Short Revised"; WAI-SR), as well as other process variables (number of logins, amount of messages sent from therapists to patients) were investigated. The results showed that non-responders had a less favorable change on the THI than responders already at mid-treatment (p < .05). The alliance (WAI-SR) during iCBT was not associated with non-response. Non-responders showed more severe sleep disturbances, logged in less in the iCBT platform, and received fewer messages from the therapists than responders, but these differences were mostly not significant anymore when correcting for multiple testing. To conclude, no symptom change in the first half of iCBT for chronic tinnitus patients is a risk factor of not benefiting from iCBT.
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Affiliation(s)
- Thomas Probst
- a Department for Psychotherapy and Biopsychosocial Health , Danube-University Krems , Krems , Austria
| | - Cornelia Weise
- b Department of Clinical Psychology and Psychotherapy , Philipps-University , Marburg , Germany.,c Department of Behavioural Sciences and Learning, Linnaeus Centre HEAD, Swedish Institute for Disability Research , Linköping University , Linköping , Sweden
| | - Gerhard Andersson
- c Department of Behavioural Sciences and Learning, Linnaeus Centre HEAD, Swedish Institute for Disability Research , Linköping University , Linköping , Sweden.,d Psychiatry Section, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Maria Kleinstäuber
- b Department of Clinical Psychology and Psychotherapy , Philipps-University , Marburg , Germany.,e School of Medicine, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
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Mander J, Neubauer AB, Schlarb A, Teufel M, Bents H, Hautzinger M, Zipfel S, Wittorf A, Sammet I. The therapeutic alliance in different mental disorders: A comparison of patients with depression, somatoform, and eating disorders. Psychol Psychother 2017; 90:649-667. [PMID: 28497909 DOI: 10.1111/papt.12131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/23/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The therapeutic alliance is intensively investigated in psychotherapy research. However, there is scarce research on the role of the specific diagnosis of the patient in the formation of the therapeutic alliance. Hence, the aim of this study was to address this research gap by comparing the alliance in different mental disorders. DESIGN Our sample comprised 348 patients (mean age = 40 years; 68% female; 133 patients with depression, 122 patients with somatoform disorders, and 93 patients with eating disorders). METHODS Patients completed the Working Alliance Inventory and measures of therapeutic outcome in early, middle, and late stages of inpatient psychotherapy. We applied multivariate multilevel models to address the nested data structure. RESULTS All three disorder groups experienced positive alliances that increased across the course of therapy and showed similar alliance-outcome relations that were of comparable strengths as in current meta-analyses. However, we found perspective incongruence of alliance ratings from patient and therapist in the three disorder groups. CONCLUSIONS Our results generally indicate that the working alliance is of importance irrespective of the specific mental disorder. Perspective incongruence feedback of working alliance experiences could help to strengthen coordination between patient and therapist and thereby improve the therapeutic process. Further implications of these findings are discussed. PRACTITIONER POINTS We found no differences in the strengths of alliance ratings and alliance-outcome associations in depressive, somatoform, and eating disorder patients. This indicates that the working alliance is of general clinical importance irrespective of the disorder group and should be a central target in all therapies. We found perspective incongruence in alliance ratings between patient and therapist in all three disorder groups. Perspective incongruence feedback of working alliance experiences could help to strengthen coordination between patient and therapist and thereby improve the therapeutic process.
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Affiliation(s)
- Johannes Mander
- Department of Psychosomatic Medicine and Psychotherapy, University of Tuebingen, Germany.,Center for Psychological Psychotherapy, University of Heidelberg, Germany
| | | | - Angelika Schlarb
- Department of Clinical Psychology, University of Bielefeld, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tuebingen, Germany
| | - Hinrich Bents
- Center for Psychological Psychotherapy, University of Heidelberg, Germany
| | - Martin Hautzinger
- Department of Clinical and Developmental Psychology, University of Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tuebingen, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Germany
| | - Isa Sammet
- Department of Psychosomatic Medicine and Psychotherapy, University of Tuebingen, Germany
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Caro Gabalda I, Stiles WB. Therapist activities preceding therapy setbacks in a poor-outcome case. COUNSELLING PSYCHOLOGY QUARTERLY 2017. [DOI: 10.1080/09515070.2017.1355295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Isabel Caro Gabalda
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Valencia, Valencia, Spain
| | - William B. Stiles
- Department of Psychology, Miami University, Oxford, OH, USA
- Department of Psychology, Appalachian State University, Boone, NC, USA
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11
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van Sonsbeek MAMS, Holtmaat CJM, Tiemens BG, Hutschemaekers GJM, de Jong K. Psychometric properties of the Dutch version of the Treatment Support Measure (TSM) parent and youth form. Clin Psychol Psychother 2017; 24:1205-1218. [PMID: 28181374 DOI: 10.1002/cpp.2075] [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] [Received: 08/12/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 11/09/2022]
Abstract
The Treatment Support Measure (TSM) Parent and Youth were created to help clinicians with actionable feedback when youths are not making sufficient progress in treatment. This study examined the psychometric properties of the Dutch TSM Parent and TSM Youth. Parents (n = 172) and youth (n = 122) were recruited at 2 outpatient mental health care institutions. Children of participating parents (50.6% boys) had a mean age of 11.9 years (SD = 3.46; range 4-18). Participating youth (30.3% boys) had a mean age of 15.68 years (SD = 1.75; range 12-18). Participants were asked to complete the TSM and questionnaires measuring related constructs once during treatment. Responses to the TSM Parent items were explained by 9 instead of 5 subscales, and responses to the TSM Youth items were explained by 8 instead of 4 subscales. The internal consistency reliability of both the TSM Parent and the TSM Youth scales was generally good. The convergent validity of the TSM Parent and the TSM Youth was also good, although the divergent validity was less convincing. The criterion validity was inconclusive; the TSM Parent was not able to differentiate between problematic and nonproblematic treatments, but multiple scales of the TSM Youth were able to differentiate between these groups. The TSM Parent and TSM Youth have potential to be helpful tools in clinical practice. They could signal potential barriers to youth progress and direct the conversation between the clinician and youth and parents about adaptation of treatment. KEY PRACTITIONER MESSAGE This is the first study to investigate the psychometric properties of the Treatment Support Measure (TSM) Parent and Youth versions, which are created to help clinicians with actionable feedback when youths are not making sufficient progress in treatment. The Dutch TSM Parent and TSM Youth have moderate to good psychometric properties. The Dutch TSM Parent and TSM Youth might be helpful tools for use in clinical practice: they contain variables that are related to youth outcome, can signal potential barriers to youth progress, and can direct the conversation between the clinician and the youth and parents about adaptation of treatment. The Dutch TSM Parent and TSM Youth could be added to the regular ROM to facilitate both routine monitoring of outcome and direct and concrete aid to the here-and-now relational processes in treatment.
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Affiliation(s)
| | - Catharina J M Holtmaat
- Department of Clinical Psychology, Emgo+ Institute for Health and Care Research, Cancer Center Amsterdam (CCA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bea G Tiemens
- Pro Persona Research, Renkum, Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Giel J M Hutschemaekers
- Pro Persona Research, Renkum, Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Kim de Jong
- Institute of Psychology, Unit Clinical Psychology, Leiden University, Leiden, Netherlands
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Schlagert HS, Hiller W. Merkmale und prädiktiver Wert von früher Verschlechterung in der ambulanten Psychotherapie. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Trotz des anhaltenden Forschungsinteresses an frühen Therapieerfolgen (Early Response), wurden frühe Verschlechterungen in bisherigen Untersuchungen eher vernachlässigt. Fragestellung: Diese Studie untersucht Merkmale und prädiktive Qualität einer frühen Verschlechterung für das Behandlungsergebnis in einer verhaltenstherapeutischen Hochschulambulanz. Methode: 1983 Patienten wurden anhand des Reliable Change Indexes (RCI) auf das Vorliegen einer frühen Verschlechterung der psychischen Belastung überprüft. Ergebnisse: Es fanden sich nur wenige charakteristische Merkmale einer frühen Verschlechterung (z. B. höhere Anzahl psychischer Störungen). Sich früh verschlechternde Patienten erreichten seltener Response (OR = 7,45) beziehungsweise Remission (OR = 11,43) und zeigten häufiger Verschlechterungen (OR = 40,68) und pathologische Abschlusswerte (OR = 5,02) zu Therapieende. Schlussfolgerung: Verschlechterungen in der frühen Therapiephase sind mit negativen Behandlungsresultaten assoziiert und sollten bei der Behandlungsplanung ambulanter Psychotherapien berücksichtigt werden.
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Affiliation(s)
| | - Wolfgang Hiller
- Psychologisches Institut, Johannes Gutenberg-Universität Mainz
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Janse PD, De Jong K, Van Dijk MK, Hutschemaekers GJM, Verbraak MJPM. Improving the efficiency of cognitive-behavioural therapy by using formal client feedback. Psychother Res 2016; 27:525-538. [PMID: 27013204 DOI: 10.1080/10503307.2016.1152408] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Feedback from clients on their view of progress and the therapeutic relationship can improve effectiveness and efficiency of psychological treatments in general. However, what the added value is of client feedback specifically within cognitive-behavioural therapy (CBT), is not known. Therefore, the extent to which the outcome of CBT can be improved is investigated by providing feedback from clients to therapists using the Outcome Rating Scale (ORS) and Session Rating Scale (SRS). METHOD Outpatients (n = 1006) of a Dutch mental health organization either participated in the "treatment as usual" (TAU) condition, or in Feedback condition of the study. Clients were invited to fill in the ORS and SRS and in the Feedback condition therapists were asked to frequently discuss client feedback. RESULTS Outcome on the SCL-90 was only improved specifically with mood disorders in the Feedback condition. Also, in the Feedback condition, in terms of process, the total number of required treatment sessions was on average two sessions fewer. CONCLUSION Frequently asking feedback from clients using the ORS/SRS does not necessarily result in a better treatment outcome in CBT. However, for an equal treatment outcome significantly fewer sessions are needed within the Feedback condition, thus improving efficiency of CBT.
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Affiliation(s)
| | - Kim De Jong
- b Department of Clinical Psychology , Leiden University , Leiden , The Netherlands
| | | | | | - Marc J P M Verbraak
- d Behavioural Science Institute , Radboud University , Nijmegen , The Netherlands
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Timman R, de Jong K, de Neve-Enthoven N. Cut-off Scores and Clinical Change Indices for the Dutch Outcome Questionnaire (OQ-45) in a Large Sample of Normal and Several Psychotherapeutic Populations. Clin Psychol Psychother 2015; 24:72-81. [PMID: 26497324 DOI: 10.1002/cpp.1979] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 08/26/2015] [Accepted: 08/27/2015] [Indexed: 11/07/2022]
Abstract
The Outcome Questionnaire-45 (OQ-45; Lambert et al., ) has been designed for frequent assessment of a patient's functioning during the course of psychotherapy and has become one of the most frequently used outcome measures in the Netherlands. The OQ-45 was originally normed on outpatients in secondary care only, but is applied in a wide variety of patient populations. As such, it has become increasingly important to provide cut-off scores with the normal population, as well as between different patient populations. The present large-scale Dutch study aims to provide cut-off scores between several populations. Data were collected from the normal population (n = 1810) and patients in five different treatment settings: outpatient primary care (n = 1581), outpatient secondary care (n = 9433), private practice (n = 457), day patient (n = 481) and inpatient therapies (n = 485), a total of more than 14.000 administrations. Reliable change indices and cut-off scores were calculated using the method of Jacobson and Truax (). The reliable change index for the patient population was calculated as 18 and the cut-off between the normal and patient population as 56. Sensitivity, specificity and area under the curves of cut-off scores between the normal population and the treatment settings were satisfactory and generally higher than 0.80. Between the patient populations, these measures were generally too low for strict use. The OQ-45 total score can satisfactorily discriminate between the normal and patient populations. For assignment to specific treatment types, the OQ-45 may help, but its use is somewhat limited in practice. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE The Dutch OQ-45 has satisfactory levels of reliability, sensitivity, specificity and area under the curve. The new overall cut-off score for normal function for the Dutch OQ-45 is 56 and the new reliable change index is 18. Cut-off scores for several therapeutic treatments are provided.
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Affiliation(s)
- Reinier Timman
- Department of Psychiatry, Medical Psychology and Psychotherapy Section, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Kim de Jong
- Leiden University, Institute of Psychology, Clinical Psychology Unit, Leiden, The Netherlands
| | - Nita de Neve-Enthoven
- Leiden University, Institute of Psychology, Clinical Psychology Unit, Leiden, The Netherlands
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Lutz W, De Jong K, Rubel J. Patient-focused and feedback research in psychotherapy: Where are we and where do we want to go? Psychother Res 2015; 25:625-32. [PMID: 26376225 DOI: 10.1080/10503307.2015.1079661] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
In the last 15 years feedback interventions have had a significant impact on the field of psychotherapy research and have demonstrated their potential to enhance treatment outcomes, especially for patients with an increased risk of treatment failure. This article serves as an introduction to the special issue on "Patient-focused and feedback research in psychotherapy: Where are we and where do we want to go?" Current investigations on feedback research are concerned with potential moderators and mediators of these effects, as well as the design and the implementation of feedback into routine care. This introduction summarizes the current state of feedback research and provides an overview of the three main research topics in this issue: (1) How to implement feedback systems into routine practice and how do therapist and patient attitudes influence its effects?, (2) How to design feedback reports and decision support tools?, and (3) What are the reasons for patients to become at risk of treatment failure and how should therapists intervene with these patients? We believe that the studies included in this special issue reflect the current state of feedback research and provide promising pathways for future endeavors that will enhance our understanding of feedback effects.
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Affiliation(s)
- Wolfgang Lutz
- a Department of Psychology , University of Trier , Trier , Germany
| | - Kim De Jong
- b Department of Clinical Psychology , Leiden University , Leiden , The Netherlands
| | - Julian Rubel
- a Department of Psychology , University of Trier , Trier , Germany
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White MM, Lambert MJ, Ogles BM, Mclaughlin SB, Bailey RJ, Tingey KM. Using the Assessment for Signal Clients as a feedback tool for reducing treatment failure. Psychother Res 2015; 25:724-34. [DOI: 10.1080/10503307.2015.1009862] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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