Treatment engagement in the early phase of cognitive-behavior therapy for panic disorder: A grounded theory analysis of patient experience

Measuring Engagement with Mental Health and Behavior Change Interventions: an Integrative Review of Methods and Instruments

BACKGROUND

Engagement is a complex construct consisting of behavioral, cognitive, and affective dimensions, making engagement a difficult construct to measure. This integrative review aims to (1) present a multidisciplinary overview of measurement methods that are currently used to measure engagement with adult mental health and behavior change interventions, delivered in-person, blended, or digitally, and (2) provide a set of recommendations and considerations for researchers wishing to study engagement.

METHODS

We used an integrative approach and identified original studies and reviews on engagement with mental health or behavior change interventions that were delivered in-person, digitally, or blended.

RESULTS

Forty articles were analyzed in this review. Common methods to assess engagement were through objective usage data, questionnaire-based data, and qualitative data, with objective usage data being used most frequently. Based on the synthesis of engagement measures, we advise researchers to (1) predefine the operationalization of engagement for their specific research context, (2) measure behavioral, cognitive, and affective dimensions of engagement in all cases, and (3) measure engagement over time.

CONCLUSIONS

Current literature shows a bias towards behavioral measures of engagement in research, as most studies measured engagement exclusively through objective usage data, without including cognitive and affective measures of engagement. We hope that our recommendations will help to reduce this bias and to steer engagement research towards an integrated approach.

Manualized single-session behavior treatment with self-help manual for panic disorder with or without agoraphobia

Objective: We examined the clinical feasibility and utility of a single behavior treatment session, with 11 patients with Panic Disorder with or without Agoraphobia (PD+/-AG). Patients used an individualized, exposure based, homework manual, derived from their behavioral analysis. Treatment was implemented in an outpatient behavior treatment unit. Method: Patients presented with moderate to severe anxiety, avoidance behavior, functional impairment and depressive symptoms. Treatment was evaluated with a double-baseline case series/pre-post design with four follow-ups. Results: There was a significant and steady improvement in all self-rated outcome measures and participants were satisfied with the services provided. Nine out of 11 patients (82%) were free of PD+/-AG at 3 months and all patients at 1-year follow-up. The absence of a control group, the small sample and lack of blind assessments, limit the validity of the study. Conclusions: These case studies provide empirical evidence in support of both the feasibility and utility of a single-session behavior treatment (SSBT) plus self-help implemented in a public mental health unit. Further research with a control group is needed to assess the efficacy of the intervention in routine clinical practice.