Pretreatment and process predictors of nonresponse at different stages of inpatient psychotherapy

[Psychosomatic health inventory: Basic psychosomatic documentation for quality assurance inpatient care]

Objectives: As part of the quality assurance of inpatient treatment, the severity of the disease and the course of therapy must be mapped. However, there is a high degree of heterogeneity in the implementation of basic diagnostics in psychosomatic facilities.There is a lack of scientifically based standardisation in determining the quality of outcomes. Methods: With the help of scientifically established test instruments, a resource-saving basic documentation instrument was developed. Many existing psychometric instruments were checked for test quality, costs and computer-supported application. Results: The Psychosomatic Health Inventory (gi-ps) consists of three basic modules with a total of 63 items: sociodemography, screening and psychosomatic health status.The latter is represented bymeans of construct-based recording on eight scales. Its collection at admission and discharge allows the presentation of the quality of outcomes.The development of a proprietary software solution with LimeSurvey enables the computer-based collection, evaluation, and storage of data. A list of test inventories for confirming diagnoses and predictors has been compiled, which are recommended for use in clinical routine. Discussion: With the gi-ps, a modular basic documentation instrument including the software solution is available to all interested institutions free of charge.

Patient experience of lasting negative effects of psychological interventions for anxiety and depression in secondary mental health care services: a national cross-sectional study

BACKGROUND

Patients who undergo psychological treatment can report both negative and positive effects, but evidence of factors influencing the likelihood of negative effects is limited.

AIMS

To identify aspects of the organisation and delivery of secondary care psychological treatment services that are associated with patient experiences of negative effects.

METHOD

Cross-sectional survey of people with anxiety and depression who ended psychological treatment delivered by 50 NHS trusts in England. Respondents were asked about how their treatment was organised and delivered and whether they experienced lasting negative effects.

RESULTS

Of 662 respondents, 90 (14.1%) reported experiencing lasting negative effects. People over the age of 65 were less likely than younger respondents to report negative effects. There was an association between reporting neutral or negative effects and not being referred at what respondents considered to be the right time (OR = 1.712, 95% CI = 1.078-2.726), not receiving the right number of sessions (OR = 3.105, 95% CI = 1.934-4.987), and not discussing progress with their therapist (OR 2.063, 95% CI = 1.290-3.301).

CONCLUSIONS

One in seven patients who took part in this survey reported lasting negative effects from psychological treatment. Steps should be taken to prepare people for the potential for negative experiences of treatment, and progress reviewed during therapy in an effort to identify and prevent negative effects.

Long-Term Effects of Home-Based Family Therapy for Non-responding Adolescents With Psychiatric Disorders. A 3-Year Follow-Up

Objective

Home-based treatment of families with low socio-economic status and multiple psychosocial problems (multi-problem families, MPFs) is gaining importance in clinical social epidemiology and health services research. The sustainability of the treatment is of special importance in order to breach transgenerational effects.

Methods

We examined outcome, effect size, and clinical significance of home-based treatment for 84 multi-problem families in a naturalistic setting. 48 of the families were available for a follow-up after 3 years. The baseline characteristics of these family systems included low collaboration, an increased family adversity index, minors with high rates of child psychiatric disorders, a high prevalence of comorbidity, low relational family functioning, and adolescents who refused any form of treatment or had unilaterally terminated different forms of treatment before. The home-based family therapy consisted of one or two face-to-face counseling sessions per week over an average of 28.8 months (SD = 19.2). The symptoms and competence of the adolescents, the caregivers, and the family structure were assessed with 13 variables.

Results

All variables showed significant improvement rates (pre- vs. post- treatment) with medium to high effect sizes (mean of Cohen's d = 1.04, range = 0.34 - 2.18). All variables showed a sustained or even further improvement at follow-up.

Conclusion

This study provides evidence of statistically (p), practically (d), and clinically (RCI) significant changes in symptom and competence-related variables among adolescents and caregivers in MPFs with sustainable long-term effects in the 3-year follow-up period.

Psychotherapiemotivation von „Pseudogesunden“

Hintergrund

Als „pseudogesund“ gelten Patienten, deren Testwerte in symptombezogenen Selbstbeurteilungsverfahren sich nicht von Personen der Allgemeinbevölkerung unterscheiden. Dennoch nehmen die „Pseudogesunden“ psychotherapeutische Behandlungen in Anspruch. Die vorliegende Studie geht daher der Frage nach, ob, und ggf. wie, sich „pseudogesunde“ Patienten in ihrer Psychotherapiemotivation von jenen mit hoher Symptombelastung unterscheiden.

Material und Methoden

Es wurden 1883 voll- und teilstationäre behandelte Patienten einer universitären Klinik für psychosomatische Medizin untersucht. Neben der Selbstbeurteilung mithilfe des „Fragebogen zur Messung der Psychotherapiemotivation“ (FMP) erfolgte die Fremdeinschätzung durch die Bezugstherapeuten auf Grundlage der Achse I „Krankheitserleben und Behandlungsvoraussetzungen“ der Operationalisierten Psychodynamischen Diagnostik (OPD-2).

Ergebnisse

Der Anteil der „Pseudogesunden“ betrug knapp 26 %. In dieser Gruppe waren somatoforme Störungen überzufällig häufig vertreten. „Pseudogesunde“ zeichneten sich im Vergleich zu den „belasteten“ Patienten sowohl in der Selbst- als auch in der Fremdbeurteilung durch einen geringeren Leidensdruck, eine an somatischen Ursachen orientierte Laienätiologie und eine insgesamt geringere Psychotherapiemotivation aus.

Diskussion

Die erhobenen Befunde deuten darauf hin, dass psychotherapiemotivierende Interventionen vor oder zu Beginn der Behandlung bei „pseudogesunden“ Patienten in erster Linie auf die Förderung eines angemessenen Krankheitsverständnisses abzielen sollten, auch um Therapieabbrüche zu vermeiden.

The capacity for psychotherapy process scale: development and psychometric validation of patient self-reports

Objective: Studies were conducted to develop and validate the Capacity for Psychotherapy Process Scale (CFPPS), a self-rating measure of capacity for the psychotherapy process from a trans-theoretical perspective. Method: In Study 1, a two-round Delphi methodology consulting 27 and 15 experts, respectively, was used to select items and identify content validity. In Study 2, 279 clients were recruited for exploratory factor analysis (EFA). In Study 3, confirmatory factor analysis and internal consistency analysis were conducted among 390 outpatients; the discriminant validity and predictive validity were studied in 270 outpatients and 82 psychotherapy outpatients, respectively. Results: The Delphi method resulted in 52 items. Through EFA, the CFPPS was reduced to 20 items, focusing on five factors: motivation, belief, self-revelation, persistence, and insight; the internal consistencies were good (0.92 for total scale and 0.82-0.91 for the factors). The CFPPS was not or was only weakly associated with symptoms. The Bonferroni-corrected partial correlation analyses revealed that the CFPPS was positively related to working alliance and session impact. Conclusions: The CFPPS is a preliminary step toward the self-report assessment of the capacity for psychotherapy process from a trans-theoretical perspective and may potentially be used to predict the working alliance and session impact.

Predicting Patterns of Treatment Response and Outcome for Adolescents Who Are Suicidal and Depressed

OBJECTIVE

Although several treatments have been shown to be effective in treatment of youth suicidal thoughts and behaviors (STBs), there is a pressing need to account for the substantial variation in adolescents' response to and outcomes from these treatments.

METHOD

Secondary analyses of data from a 16-week randomized trial of Attachment-Based Family Therapy (ABFT) and Family-Enhanced NonDirective Supportive Therapy (FE-NST) identified distinct classes of adolescents' treatment response. Established risk factors for STBs, along with treatment condition and sociodemographic variables, were then tested as predictors of class membership.

RESULTS

Three patterns of adolescents' treatment response and outcome were identified: a) nonresponders (15.8%), b) good responders (57.5%), and c) partial responders (26.7%). After controlling for initial symptom severity, nonresponders were more likely to have higher levels of nonsuicidal self-injury and pessimism and were more likely to meet diagnostic criteria for major depressive disorder (MDD) than good or partial responders. Partial responders were more likely than good responders to meet criteria for MDD and to have higher perceived burdensomeness.

CONCLUSION

Although most adolescents showed significant symptom reductions with both treatments, adolescents with higher pretreatment levels of pessimism, MDD, nonsuicidal self-injury, and perceived burdensomeness were less likely to show an optimal pattern of treatment benefit. The findings point to heterogeneity in treatment response that may require adapting treatments for adolescents with these pretreatment profiles.

CLINICAL TRIAL REGISTRATION INFORMATION

Attachment-Based Family Therapy for Suicidal Adolescents; http://clinicaltrials.gov; NCT01537419.