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Willemsen RF, Versluis A, Aardoom JJ, Petrus AHJ, Silven AV, Chavannes NH, van Dijke A. Evaluation of completely online psychotherapy with app-support versus therapy as usual for clients with depression or anxiety disorder: A retrospective matched cohort study investigating the effectiveness, efficiency, client satisfaction, and costs. Int J Med Inform 2024; 189:105485. [PMID: 38815315 DOI: 10.1016/j.ijmedinf.2024.105485] [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: 01/25/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Depressive and anxiety disorders are common mental disorders ranking among the leading causes of global disease burden. Not all clients currently benefit from therapy and clients are looking for modern ways of therapy. Online psychotherapy is a promising option for better meeting clients' needs. Recently, a new psychotherapy concept has emerged that combines videoconferencing sessions with support through a mobile application. The latter allows for ecological momentary assessments and interventions, facilitates communication between patients and therapists in between sessions through chat, and allows for incorporating feedback-informed treatment principles. MATERIAL AND METHODS The study was a retrospective observational matched cohort study, comparing online psychotherapy with Therapy As Usual (TAU) for clients with depressive or anxiety disorders. Data were obtained via questionnaires, which are part of standard clinical care. Primary outcomes included general mental functioning, and symptoms of depression and anxiety. Secondary outcomes were efficiency, client satisfaction, and therapy costs. Primary endpoints were analyzed using linear mixed models analysis, with an interaction term between time and group. Secondary outcomes were analyzed using linear regression. RESULTS Larger improvements were observed in the online compared to the TAU group for general mental functioning and depressive disorder (i.e., General mental functioning: B = -8.50, 95 CI: -15.01 - -1.97, p = 0.011; Depressive disorder: B = - 3.66, 95 % CI: -5.79 - -1.54p < 0.01). No significant differences in change over time between the two groups were observed for anxiety disorder (B = -3.64, 95 % CI: (-13.10 - 5.82) p = 0.447). The total number of sessions was significantly higher in the online psychotherapy group than in TAU (B = 3.71, p < 0.01), although clients were matched on treatment time in weeks. Treatment session duration in minutes was comparable across the groups. DISCUSSION Online psychotherapy with app support showed to be a promising alternative to TAU for depressive and anxiety disorders. More research is needed to evaluate the effectiveness, cost-effectiveness and client satisfaction of online psychotherapy compared to TAU, such as randomized controlled trials or studies multiple baseline series designs, and in-depth qualitative research.
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Affiliation(s)
- Romy Fleur Willemsen
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, The Netherlands, Department of Public Health and Primary Care, 2333 ZA the Netherlands.
| | - Anke Versluis
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, The Netherlands, Department of Public Health and Primary Care, 2333 ZA the Netherlands.
| | - Jiska Joëlle Aardoom
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, The Netherlands, Department of Public Health and Primary Care, 2333 ZA the Netherlands.
| | - Annelieke Hermina Josephina Petrus
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, The Netherlands, Department of Public Health and Primary Care, 2333 ZA the Netherlands.
| | - Anna Veronica Silven
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, The Netherlands, Department of Public Health and Primary Care, 2333 ZA the Netherlands.
| | - Niels Henrik Chavannes
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, The Netherlands, Department of Public Health and Primary Care, 2333 ZA the Netherlands.
| | - Annemiek van Dijke
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Parnassia Psychiatric Institute, The Netherlands, PsyQ online, The Hague 2553 RJ, the Netherlands.
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McKenna S, Hutcheon A, Gorban C, Song Y, Scott E, Hickie I. Youth Perspectives on 'Highly Personalised and Measurement-Based Care': Qualitative Co-Design of Education Materials. Health Expect 2024; 27:e14137. [PMID: 38976368 PMCID: PMC11229696 DOI: 10.1111/hex.14137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/15/2024] [Accepted: 06/19/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVES Despite high levels of mental ill-health amongst young people (aged 15-30), this group demonstrates low help-seeking and high drop-out from mental health services (MHS). Whilst shared decision-making can assist people in receiving appropriate and effective health care, young people frequently report that they do not feel involved in treatment decisions. The current study focused on co-design of a clinical education and participant information programme for the Brain and Mind Centre Youth Model of Care. This model, which articulates a youth-focused form of highly personalised and measurement-based care, is designed to promote shared decision-making between young people and clinical service providers. METHODS We conducted workshops with 24 young people (16-31; MAge = 21.5) who had accessed mental health services. Participants were asked what advice they would give to young people entering services, before giving advice on existing materials. Workshops were conducted and transcripts were coded using thematic analysis by two lived experience researchers and a clinical researcher. RESULTS Young people found it empowering to be educated on transdiagnostic models of mental illness, namely clinical staging, which gives them a better understanding of why certain treatments may be inappropriate and ineffective, and thus reduce self-blame. Similarly, young people had limited knowledge of links between mental health and other life domains and found it helpful to be educated on multidisciplinary treatment options. Measurement-based care was seen as an important method of improving shared decision-making between young people and health professionals; however, to facilitate shared decision-making, young people also wanted better information on their rights in care and more support to share their expertise in their own needs, values and treatment preferences. CONCLUSIONS These findings will inform the delivery of the further development and implementation of a youth-specific clinical education and participant information programme for the BMC Youth Model. PATIENT OR PUBLIC CONTRIBUTION Workshops were facilitated by researchers with lived expertise in mental ill-health (A.H. and/or C.G.) and a clinical researcher (who has expertise as an academic and a clinical psychologist). A.H. and C.G. were also involved in conceptualisation, analysis, interpretation, review and editing of this paper.
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Affiliation(s)
- Sarah McKenna
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alexis Hutcheon
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Carla Gorban
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun Song
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth Scott
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ian Hickie
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Anderson SR, Johnson LN, Witting AB, Miller RB, Bradford AB, Hunt QA, Bean RA. Validation of the intersession alliance measure: Individual, couple, and family versions. JOURNAL OF MARITAL AND FAMILY THERAPY 2024; 50:589-610. [PMID: 38567892 DOI: 10.1111/jmft.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 07/05/2024]
Abstract
Monitoring the therapeutic alliance throughout treatment can improve client outcomes and lead to improved care. The individual, couple, and family versions of the intersession alliance measure (IAM) were developed to facilitate routine monitoring of the expanded therapeutic alliance. Psychometric properties of the three versions of the IAM were examined using a clinical sample. Participants were drawn from clinics in the United States participating in the Marriage and Family Therapy Practice Research Network. Using this sample, results indicate that items on each version of the IAM load on one factor, are invariant across sex, and that each version has good internal consistency, test-retest reliability, and concurrent validity. The IAM-C and IAM-F also have good predictive validity, while the IAM-I has more limited evidence for its predictive validity. These results suggest that the IAMs are valid and reliable measures that can facilitate the routine monitoring of the expanded therapeutic alliance in psychotherapy.
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Affiliation(s)
| | - Lee N Johnson
- School of Family Life, Brigham Young University, Provo, Utah, USA
| | | | - Richard B Miller
- School of Family Life, Brigham Young University, Provo, Utah, USA
| | | | - Quintin A Hunt
- School of Family Life, Brigham Young University, Provo, Utah, USA
| | - Roy A Bean
- School of Family Life, Brigham Young University, Provo, Utah, USA
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Zipfel S, Lutz W, Schneider S, Schramm E, Delgadillo J, Giel KE. The Future of Enhanced Psychotherapy: Towards Precision Psychotherapy. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:230-236. [PMID: 38934154 DOI: 10.1159/000539022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Stephan Zipfel
- Department of Psychosomatic Medicine, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence in Eating Disorders (KOMET), Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
| | - Wolfgang Lutz
- German Center for Mental Health (DZPG), Tübingen, Germany
- Department of Psychology, University of Trier, Trier, Germany
| | - Silvia Schneider
- German Center for Mental Health (DZPG), Bochum, Germany
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Elisabeth Schramm
- German Center for Mental Health (DZPG), Tübingen, Germany
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Katrin E Giel
- Department of Psychosomatic Medicine, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence in Eating Disorders (KOMET), Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
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Di Basilio D, King L, Lloyd S, Michael P, Shardlow M. Asking questions that are "close to the bone": integrating thematic analysis and natural language processing to explore the experiences of people with traumatic brain injuries engaging with patient-reported outcome measures. Front Digit Health 2024; 6:1387139. [PMID: 38983792 PMCID: PMC11231399 DOI: 10.3389/fdgth.2024.1387139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/13/2024] [Indexed: 07/11/2024] Open
Abstract
Introduction Patient-reported outcomes measures (PROMs) are valuable tools for assessing health-related quality of life and treatment effectiveness in individuals with traumatic brain injuries (TBIs). Understanding the experiences of individuals with TBIs in completing PROMs is crucial for improving their utility and relevance in clinical practice. Methods Sixteen semi-structured interviews were conducted with a sample of individuals with TBIs. The interviews were transcribed verbatim and analysed using Thematic Analysis (TA) and Natural Language Processing (NLP) techniques to identify themes and emotional connotations related to the experiences of completing PROMs. Results The TA of the data revealed six key themes regarding the experiences of individuals with TBIs in completing PROMs. Participants expressed varying levels of understanding and engagement with PROMs, with factors such as cognitive impairments and communication difficulties influencing their experiences. Additionally, insightful suggestions emerged on the barriers to the completion of PROMs, the factors facilitating it, and the suggestions for improving their contents and delivery methods. The sentiment analyses performed using NLP techniques allowed for the retrieval of the general sentimental and emotional "tones" in the participants' narratives of their experiences with PROMs, which were mainly characterised by low positive sentiment connotations. Although mostly neutral, participants' narratives also revealed the presence of emotions such as fear and, to a lesser extent, anger. The combination of a semantic and sentiment analysis of the experiences of people with TBIs rendered valuable information on the views and emotional responses to different aspects of the PROMs. Discussion The findings highlighted the complexities involved in administering PROMs to individuals with TBIs and underscored the need for tailored approaches to accommodate their unique challenges. Integrating TA-based and NLP techniques can offer valuable insights into the experiences of individuals with TBIs and enhance the interpretation of qualitative data in this population.
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Affiliation(s)
- Daniela Di Basilio
- Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Lorraine King
- Department of Neuropsychology, North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, United Kingdom
| | - Sarah Lloyd
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
| | - Panayiotis Michael
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
| | - Matthew Shardlow
- Department of Computing and Mathematics, Manchester Metropolitan University, Manchester, United Kingdom
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Edelbluth S, Klein JP, Schwartz B, Hehlmann M, Arndt A, Rubel J, Moggia D, Berger T, Meyer B, Moritz S, Schröder J, Lutz W. The long shadow of early-change patterns: a 3-year follow-up after the use of a web-based intervention for mild to moderate depressive symptoms. Cogn Behav Ther 2024:1-20. [PMID: 38912859 DOI: 10.1080/16506073.2024.2368520] [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: 12/25/2023] [Accepted: 05/31/2024] [Indexed: 06/25/2024]
Abstract
Web-based interventions can be effective in treating depressive symptoms. Patients with risk not responding to treatment have been identified by early change patterns. This study aims to examine whether early changes are superior to baseline parameters in predicting long-term outcome. In a randomized clinical trial with 409 individuals experiencing mild to moderate depressive symptoms using the web-based intervention deprexis, three latent classes were identified (early response after registration, early response after screening and early deterioration) based on early change in the first four weeks of the intervention. Baseline variables and these classes were included in a Stepwise Cox Proportional Hazard Multiple Regression to identify predictors associated with the onset of remission over 36-months. Early change class was a significant predictor of remission over 36 months. Compared to early deterioration after screening, both early response after registration and after screening were associated with a higher likelihood of remission. In sensitivity and secondary analyses, only change class consistently emerged as a predictor of long-term outcome. Early improvement in depression symptoms predicted long-term outcome and those showing early improvement had a higher likelihood of long-term remission. These findings suggest that early changes might be a robust predictor for long-term outcome beyond baseline parameters.
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Affiliation(s)
- Susanne Edelbluth
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Brian Schwartz
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Miriam Hehlmann
- Department of Clinical Psychology and Psychotherapy for Adults, Osnabrueck University, Osnabrueck, Germany
| | - Alice Arndt
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Julian Rubel
- Department of Clinical Psychology and Psychotherapy for Adults, Osnabrueck University, Osnabrueck, Germany
| | - Danilo Moggia
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Thomas Berger
- Department of Psychology, Bern University, Bern, Switzerland
| | | | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Johanna Schröder
- Department of Psychology, MSH Medical School Hamburg, Institute of Clinical Psychology and Psychotherapy, Hamburg, Germany
| | - Wolfgang Lutz
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
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Schramm E, Elsaesser M, Jenkner C, Hautzinger M, Herpertz SC. Algorithm-based modular psychotherapy vs. cognitive-behavioral therapy for patients with depression, psychiatric comorbidities and early trauma: a proof-of-concept randomized controlled trial. World Psychiatry 2024; 23:257-266. [PMID: 38727062 PMCID: PMC11083959 DOI: 10.1002/wps.21204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
Effect sizes of psychotherapies currently stagnate at a low-to-moderate level. Personalizing psychotherapy by algorithm-based modular procedures promises improved outcomes, greater flexibility, and a better fit between research and practice. However, evidence for the feasibility and efficacy of modular-based psychotherapy, using a personalized treatment algorithm, is lacking. This proof-of-concept randomized controlled trial was conducted in 70 adult outpatients with a primary DSM-5 diagnosis of major depressive disorder, a score higher than 18 on the 24-item Hamilton Rating Scale for Depression (HRSD-24), at least one comorbid psychiatric diagnosis according to the Structured Clinical Interview for DSM-5 (SCID-5), a history of at least "moderate to severe" childhood maltreatment on at least one domain of the Childhood Trauma Questionnaire (CTQ), and exceeding the cut-off value on at least one of three measures of early trauma-related transdiagnostic mechanisms: the Rejection Sensitivity Questionnaire (RSQ), the Interpersonal Reactivity Index (IRI), and the Difficulties in Emotion Regulation Scale-16 (DERS-16). Patients were randomized to 20 sessions of either standard cognitive-behavioral therapy alone (CBT) or CBT plus transdiagnostic modules according to a mechanism-based treatment algorithm (MoBa), over 16 weeks. We aimed to assess the feasibility of MoBa, and to compare MoBa vs. CBT with respect to participants' and therapists' overall satisfaction and ratings of therapeutic alliance (using the Working Alliance Inventory - Short Revised, WAI-SR), efficacy, impact on early trauma-related transdiagnostic mechanisms, and safety. The primary outcome for efficacy was the HRSD-24 score at post-treatment. Secondary outcomes included, among others, the rate of response (defined as a reduction of the HRSD-24 score by at least 50% from baseline and a score <16 at post-treatment), the rate of remission (defined as a HRSD-24 score ≤8 at post-treatment), and improvements in early trauma-related mechanisms of social threat response, hyperarousal, and social processes/empathy. We found no difficulties in the selection of the transdiagnostic modules in the individual patients, applying the above-mentioned cut-offs, and in the implementation of MoBa. Both participants and therapists reported higher overall satisfaction and had higher WAI-SR ratings with MoBa than CBT. Both approaches led to major reductions of depressive symptoms at post-treatment, with a non-significant superiority of MoBa over CBT. Patients randomized to MoBa were nearly three times as likely to experience remission at the end of therapy (29.4% vs. 11.4%; odds ratio, OR = 3.2, 95% CI: 0.9-11.6). Among mechanism-based outcomes, MoBa patients showed a significantly higher post-treatment effect on social processes/empathy (p<0.05) compared to CBT patients, who presented an exacerbation on this domain at post-treatment. Substantially less adverse events were reported for MoBa compared to CBT. These results suggest the feasibility and acceptability of an algorithm-based modular psychotherapy complementing CBT in depressed patients with psychiatric comorbidities and early trauma. While initial evidence of efficacy was observed, potential clinical advantages and interindividual heterogeneity in treatment outcomes will have to be investigated in fully powered confirmation trials.
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Affiliation(s)
- Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Moritz Elsaesser
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carolin Jenkner
- Clinical Trials Unit, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology, and Psychotherapy, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim/Heidelberg/Ulm, Germany
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Haug IM, Neumer SP, Handegård BH, Lisøy C, Rasmussen LMP, Bania EV, Adolfsen F, Patras J. Dose-Response Effects of MittEcho, a Measurement Feedback System, in an Indicated Mental Health Intervention for Children in Municipal and School Services in Norway. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01389-9. [PMID: 38809322 DOI: 10.1007/s10488-024-01389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 05/30/2024]
Abstract
Including routine client feedback can increase the effectiveness of mental health interventions for children, especially when implemented as intended. Rate of implementation, or dose, of such feedback interventions has been shown to moderate results in some studies. Variation in implementation and use of client feedback may also contribute to the mixed results observed within the feedback literature. This study evaluates dose-response associations of client feedback using a novel Measurement Feedback System (MFS) within an indicated group intervention. The primary aim was to determine whether the rate of MFS implementation predicts symptom reduction in anxiety and depression among school-aged children. The secondary aim was to assess whether the rate of MFS implementation influences children's satisfaction with the group intervention or their dropout rates. Data were collected via a randomized factorial study (clinicaltrials.gov NCT04263558) across 58 primary schools in Norway. Children aged 8 to 12 years (N = 701) participated in a group-based, transdiagnostic intervention targeting elevated symptoms of anxiety or depression. Half of the child groups also received the feedback intervention using the MittEcho MFS. Group leaders (N = 83), recruited locally, facilitated the interventions. The MFS dose was measured using the Implementation Index, which combines the use of MFS by both children and providers (group leaders) into a single dose variable. Results showed no significant additional effect of dose of MFS on change in depression or anxiety scores, on user satisfaction with the intervention or on intervention dropout. The discussion addresses potential reasons for these non-significant findings and implications for MFS implementation in preventive, group-based interventions in school settings.
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Affiliation(s)
- Ida Mari Haug
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway.
| | - Simon-Peter Neumer
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Bjørn Helge Handegård
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Carina Lisøy
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Lene-Mari P Rasmussen
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Elisabeth Valmyr Bania
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frode Adolfsen
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Joshua Patras
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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de Jong K, Douglas S, Wolpert M, Delgadillo J, Aas B, Bovendeerd B, Carlier I, Compare A, Edbrooke-Childs J, Janse P, Lutz W, Moltu C, Nordberg S, Poulsen S, Rubel JA, Schiepek G, Schilling VNLS, van Sonsbeek M, Barkham M. Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01381-3. [PMID: 38733413 DOI: 10.1007/s10488-024-01381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed.
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Affiliation(s)
- Kim de Jong
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands.
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, Nashville, TN, USA
| | - Miranda Wolpert
- Division of Psychology and Language Sciences, Department of Clinical, Education and Health Psychology, University College London, United Kingdom, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Benjamin Aas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Faculty of Psychology and Educational Sciences, LMU Munich, Munich, Germany
| | - Bram Bovendeerd
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- Dimence, Center for mental health care, Deventer, The Netherlands
| | - Ingrid Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, London, UK
| | | | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Christian Moltu
- District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway
| | - Samuel Nordberg
- Department of Behavioral Health, Reliant Medical Group, Worcester, MA, USA
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Julian A Rubel
- Institute of Psychology, University of Osnabrück, Salzburg, Austria
| | - Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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10
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McAleavey AA, de Jong K, Nissen-Lie HA, Boswell JF, Moltu C, Lutz W. Routine Outcome Monitoring and Clinical Feedback in Psychotherapy: Recent Advances and Future Directions. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:291-305. [PMID: 38329643 PMCID: PMC11076375 DOI: 10.1007/s10488-024-01351-9] [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] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
In the past decade, there has been an increase in research related to the routine collection and active use of standardized patient data in psychotherapy. Research has increasingly focused on personalization of care to patients, clinical skills and interventions that modulate treatment outcomes, and implementation strategies, all of which appear to enhance the beneficial effects of ROM and feedback. In this article, we summarize trends and recent advances in the research on this topic and identify several essential directions for the field in the short to medium term. We anticipate a broadening of research from the focus on average effects to greater specificity around what kinds of feedback, provided at what time, to which individuals, in what settings, are most beneficial. We also propose that the field needs to focus on issues of health equity, ensuring that ROM can be a vehicle for increased wellbeing for those who need it most. The complexity of mental healthcare systems means that there may be multiple viable measurement solutions with varying costs and benefits to diverse stakeholders in different treatment contexts, and research is needed to identify the most influential components in each of these contexts.
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Affiliation(s)
- Andrew A McAleavey
- Helse Førde Hospital Trust, Svanehaugvegen 2, Førde, 6812, Norway.
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway.
- Department of Psychiatry, Weill Cornell Medical Center, New York, NY, USA.
| | - Kim de Jong
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
| | | | - James F Boswell
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Christian Moltu
- Helse Førde Hospital Trust, Svanehaugvegen 2, Førde, 6812, Norway
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
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11
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Douglas S, Page AC, Moltu C, Kyron M, Satterthwaite T. The Connections Matter: Bi-Directional Learning in Program Evaluation and Practice-Oriented Research. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:318-335. [PMID: 37768486 DOI: 10.1007/s10488-023-01304-8] [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] [Accepted: 09/17/2023] [Indexed: 09/29/2023]
Abstract
Intended for researchers and clinical leaders, this article suggests that embedded program evaluation is a good fit with the desired features of practice-oriented research. The systematic nature of evaluation that is built into the operational workflow of a practice setting may increase the diversity of methods available to explore processes and outcomes of interest. We propose a novel conceptual framework that uses a human-centered systems lens to foster such embedded evaluation in clinical routine. This approach emphasizes the evaluator-practitioner partnership to build confidence in the bi-directional learning of practice-based evidence with evidence-based practice. The iterative cycles inherent to design thinking are aimed at developing better evaluation questions. The attention to structure and context inherent to systems thinking is intended to support meaningful perspectives in the naturally complex world of health care. Importantly, the combined human-centered systems lens can create greater awareness of the influence of individual and systemic biases that exist in any endeavor or institution that involves people. Recommended tools and strategies include systems mapping, program theory development, and visual facilitation using a logic model to represent the complexity of mental health treatment for communication, shared understanding, and connection to the broader evidence base. To illustrate elements of the proposed conceptual framework, two case examples are drawn from routine outcome monitoring (ROM) and progress feedback. We conclude with questions for future collaboration and research that may strengthen the partnership of evaluators and practitioners as a community of learners in service of local and system-level improvement.
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Affiliation(s)
- Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA.
| | - Andrew C Page
- School of Psychological Science and WA Mental Health Research Centre, University of Western Australia, Perth, Australia
| | - Christian Moltu
- District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway
| | - Michael Kyron
- School of Psychological Science and WA Mental Health Research Centre, University of Western Australia, Perth, Australia
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12
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Scholten S, Rubel JA, Glombiewski JA, Milde C. What time-varying network models based on functional analysis tell us about the course of a patient's problem. Psychother Res 2024:1-19. [PMID: 38588679 DOI: 10.1080/10503307.2024.2328304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Relations among psychological variables are assumed to be complex and to vary over time. Personalized networks can model multivariate complex interactions. The development of time-varying networks allows to model the variation of parameters over time. Objectives: We aimed to determine the value of time-varying networks for clinical practice. Methods: We applied time-varying mixed graphical models (TV-MGM) and time-varying vector autoregressive models (TV-VAR) to intensive longitudinal data of nine participants with depressive symptoms (n = 6) or anxiety (n = 3). Results: Most of the participants showed temporal changes in network topology within the assessment period of 30 days. Time-varying networks of participants with small, medium, and large time variability in edge parameters clearly show the different temporal evolvements of dynamic interactions between variables. The case example indicates clinical utility but also limitations to the application of time-varying networks in clinical practice. Conclusion: Time-varying network models provide a data-driven and exploratory approach that could complement current diagnostic standards by reflecting interacting, often mutually reinforcing processes of mental health problems and by accounting for variation over time. They can be used to generate hypotheses for further confirmatory and clinical testing.
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Affiliation(s)
- Saskia Scholten
- RPTU Kaiserslautern-Landau, Pain and Psychotherapy Research Lab, Landau, Germany
| | - Julian A Rubel
- Psychotherapy Research Lab, Osnabrueck University, Osnabrueck, Germany
| | - Julia A Glombiewski
- RPTU Kaiserslautern-Landau, Pain and Psychotherapy Research Lab, Landau, Germany
| | - Christopher Milde
- RPTU Kaiserslautern-Landau, Pain and Psychotherapy Research Lab, Landau, Germany
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13
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Lutz W, Schwartz B, Deisenhofer AK, Schaffrath J, Eberhardt ST, Bommer J, Vehlen A, Moggia D, Poster K, Weinmann-Lutz B, Rubel JA, Hehlmann MI. From Theory to Practice: A Transtheoretical Treatment and Training Model (4TM). CLINICAL PSYCHOLOGY IN EUROPE 2024; 6:e12421. [PMID: 39118650 PMCID: PMC11303928 DOI: 10.32872/cpe.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/14/2023] [Indexed: 08/10/2024] Open
Abstract
Background In this paper, we present the conceptual background and clinical implications of a research-based transtheoretical treatment and training model (4TM). Method The model implements findings from psychotherapy outcome, process, and feedback research into a clinical and training framework that is open to future research. Results The framework is based on interventions targeting patient processes on a behavioral, cognitive, emotional, motivational, interpersonal, and systemic/socio-cultural level. The 4TM also includes a data-based decision support and feedback system called the Trier Treatment Navigator (TTN). Conclusion We discuss important problems associated with clinical orientations solely based on one school of thought. We then contrast these concerns with a clinical and training framework that embraces ongoing research, serving as a guiding structure for process-based transtheoretical interventions. Such research-based psychological therapy can take both traditional and novel clinical developments as well as findings from psychotherapy research into account and be adaptively disseminated to a variety of patient populations.
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Affiliation(s)
- Wolfgang Lutz
- Department of Psychology, Trier University, Trier, Germany
| | - Brian Schwartz
- Department of Psychology, Trier University, Trier, Germany
| | | | | | | | - Jana Bommer
- Department of Psychology, Trier University, Trier, Germany
| | - Antonia Vehlen
- Department of Psychology, Trier University, Trier, Germany
| | - Danilo Moggia
- Department of Psychology, Trier University, Trier, Germany
| | - Kaitlyn Poster
- Department of Psychology, Trier University, Trier, Germany
| | | | - Julian A. Rubel
- Department of Psychology, Osnabrück University, Osnabrück, Germany
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14
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Flückiger C, Willutzki U, grosse Holtforth M, Wampold BE. Psychotherapy Works - An Inclusive and Affirming View to a Modern Mental Health Treatment. CLINICAL PSYCHOLOGY IN EUROPE 2024; 6:e11971. [PMID: 39118651 PMCID: PMC11303923 DOI: 10.32872/cpe.11971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2024] Open
Abstract
Psychotherapy is a highly collaborative and individualized mental health practice developed in (post-) modern societies. The mental health outcomes of psychotherapy cover a broad range of psychological factors including the reduction of suffering/symptoms as well as the promotion of well-being, personal values, and personal strengths. There is extensive meta-analytic evidence that legitimate psychotherapy works remarkably well and robustly for most common mental disorders. In addition, there is a large body of meta-analytic evidence supporting the potential relevance of transdiagnostic relationship principles and transtheoretical psychotherapy factors. Based on this ongoing empirical evidence, we propose four relevant implications for future training and practice in transdiagnostic psychotherapy: 1) the development of a transtheoretical legal framework for psychotherapeutic treatments, 2) the formulation of evidence-based transtheoretical interpersonal skills, 3) an orientation toward transtheoretical therapeutic factors, and 4) the exploration of comprehensive psychotherapy outcomes. We conclude with some more general guidance for future directions.
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Affiliation(s)
| | - Ulrike Willutzki
- Department of Psychology, Witten/Herdecke University, Witten, Germany
| | - Martin grosse Holtforth
- Department of Psychology, University of Bern, Bern, Switzerland
- Hospital Insel, Bern, Switzerland
| | - Bruce E. Wampold
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
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Boswell JF, Constantino MJ, Gaines AN, Smith AE. Responding to Key Process Markers as a Focus of Psychotherapy Training and Practice. CLINICAL PSYCHOLOGY IN EUROPE 2024; 6:e11967. [PMID: 39118659 PMCID: PMC11303932 DOI: 10.32872/cpe.11967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2024] Open
Abstract
Historically, evidence-based psychotherapy training has favored the standardized application of discrete treatment packages, with key outcomes being the therapist's adherence to and competent delivery of theory-prescribed ingredients. However, this model often fails to align with the priorities and values of clinicians, and research casts doubt on the notion that a therapist's faithful application of treatment protocols is a valid index of clinical expertise. Considering this, training and practice models that emphasize evidence-based clinician flexibility and patient-centered tailoring of interventions are receiving increased attention. In this article, we outline one such model informed by the context-responsive psychotherapy integration (CRPI) framework. Consistent with CRPI principles, we describe several "if this/then try that" marker-response sequences that could become a centerpiece of a more nuanced, clinically representative, and evidence-based psychotherapy training paradigm. Finally, we offer several recommendations for future work on CRPI.
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Affiliation(s)
- James F. Boswell
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Michael J. Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - Averi N. Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - Ashleigh E. Smith
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
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16
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Jonášová K, Čevelíček M, Doležal P, Řiháček T. Psychotherapists' Experience with In-Session Use of Routine Outcome Monitoring: A Qualitative Meta-analysis. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01348-4. [PMID: 38507028 DOI: 10.1007/s10488-024-01348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 03/22/2024]
Abstract
Routine outcome monitoring (ROM) has become an increasingly utilized tool in therapeutic practice that has the potential to improve therapy outcomes. This study aimed to synthesize the findings of existing qualitative studies investigating how clinicians use ROM in their work with clients. A systematic search of qualitative studies on clinicians' experience with the use of ROM in mental health services was conducted via PsycInfo, PsycArticles, Medline, Web of Science, and Scopus databases. Qualitative meta-analysis was used to synthesize the finding of the primary studies. Forty-seven studies met the inclusion criteria. The analysis resulted in 21 meta-categories organized into six clusters, namely (1) obtaining clinically relevant information, (2) adapting treatment, (3) facilitating communication, (4) enhancing the therapeutic relationship, (5) facilitating change in clients, and (6) personalized usage of ROM. The meta-analysis revealed that clinicians utilized ROM in diverse ways, including both informational and communicational functions. From the clinicians' perspective, ROM was an element that, on the one hand, introduced additional structure and standardization in treatment and, on the other hand, allowed for greater flexibility and tailoring of treatment.
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Affiliation(s)
- Klára Jonášová
- Department of Psychology, Faculty of Social Studies, Masaryk University, Joštova 10, 602 00, Brno, Czech Republic.
| | - Michal Čevelíček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Joštova 10, 602 00, Brno, Czech Republic
| | - Petr Doležal
- Department of Psychology, Faculty of Social Studies, Masaryk University, Joštova 10, 602 00, Brno, Czech Republic
| | - Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Joštova 10, 602 00, Brno, Czech Republic
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17
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Stefana A, Fusar-Poli P, Vieta E, Gelso CJ, Youngstrom EA. Development and validation of an 8-item version of the Real Relationship Inventory-Client form. Psychother Res 2024:1-17. [PMID: 38497741 DOI: 10.1080/10503307.2024.2320331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To develop and validate a very brief version of the 24-item Real Relationship Inventory-Client (RRI-C) form. METHOD Two independent samples of individual psychotherapy patients (Nsample1 = 700, Nsample2 = 434) completed the RRI-C along with other measures. Psychometric scale shortening involved exploratory factor analysis, item response theory analysis, confirmatory factor analysis (CFA), and multigroup CFA. Reliability and convergent and discriminant validity of the scale and subscales were also assessed. RESULTS The 8-item RRI-C (RRI-C-SF) preserves the two-factor structure: Genuineness (k = 4, α = .86) and Realism (k = 4, α = .87), which were correlated at r = .74. CFA provided the following fit indices for the bifactor model: X2/df = 2.16, CFI = .99, TLI = .96, RMSEA = .07, and SRMR = .03. Multigroup CFA showed that the RRI-C-SF was invariant across in-person and remote session formats. The RRI-C-SF demonstrated high reliability (α = .91); high correlation with the full-length scale (r = .96); and excellent convergent and discriminant validity with measures of other elements of the therapeutic relationship, personality characteristics, current mental health state, and demographic-clinical variables. Clinical change benchmarks were calculated to serve as valuable tools for both research and clinical practice. CONCLUSION The RRI-C-SF is a reliable measure that can be used for both research and clinical purposes. It enables a nuanced assessment of the genuineness and the realism dimensions of the real relationship.
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Affiliation(s)
- Alberto Stefana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Charles J Gelso
- Department of Psychology, University of Maryland, College Park, MA, USA
| | - Eric A Youngstrom
- Institute for Mental and Behavioral Health Research, Nationwide Children's Hospital and Department of Psychiatry, The Ohio State University, Columbus, OH, USA
- Helping Give Away Psychological Science, 501c3
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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18
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van Dalen M, Snijders A, Dietvorst E, Bracké K, Nijhof SL, Keijsers L, Hillegers MHJ, Legerstee JS. Applications of the experience sampling method (ESM) in paediatric healthcare: a systematic review. Pediatr Res 2024; 95:887-900. [PMID: 38062256 PMCID: PMC10920184 DOI: 10.1038/s41390-023-02918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND With the Experience Sampling Method (ESM) participants are asked to provide self-reports of their symptoms, feelings, thoughts and behaviours in daily life. This preregistered systematic review assessed how ESM is being used to monitor emotional well-being, somatic health, fatigue and pain in children and adolescents with a chronic somatic illness. METHODS Databases were searched from inception. Studies were selected if they included children or adolescents aged 0-25 years with a chronic somatic illness and used ESM focussing on mental health or psychosocial wellbeing, biopsychosocial factors and/or somatic health. Two reviewers extracted data of the final 47 papers, describing 48 studies. RESULTS Most studies evaluated what factors influence medical or psychological symptoms and how symptoms influence each other. Another common purpose was to study the feasibility of ESM or ESM as part of an app or intervention. Study methods were heterogeneous and most studies lack adequate reporting of ESM applications and results. CONCLUSIONS While ESM holds great potential for providing results and feedback to patients and caregivers, little use is being made of this option. Future studies should consider what they report in their studies, conduct a priori power analyses and how ESM can be embedded in clinical practice. IMPACT While ESM has many clinical applications, it is currently mostly used for research purposes. Current studies using ESM are heterogeneous and lack consistent, high-quality reporting. There is great potential in ESM for providing patients and parents with personalised feedback.
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Affiliation(s)
- Marije van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Anne Snijders
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Evelien Dietvorst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Katrien Bracké
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Sanne L Nijhof
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Loes Keijsers
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
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Zilcha-Mano S. Individual-Specific Animated Profiles of Mental Health. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2024:17456916231226308. [PMID: 38377015 DOI: 10.1177/17456916231226308] [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: 02/22/2024]
Abstract
How important is the timing of the pretreatment evaluation? If we consider mental health to be a relatively fixed condition, the specific timing (e.g., day, hour) of the evaluation is immaterial and often determined on the basis of technical considerations. Indeed, the fundamental assumption underlying the vast majority of psychotherapy research and practice is that mental health is a state that can be captured in a one-dimensional snapshot. If this fundamental assumption, underlying 80 years of empirical research and practice, is incorrect, it may help explain why for decades psychotherapy failed to rise above the 50% efficacy rate in the treatment of mental-health disorders, especially depression, a heterogeneous disorder and the leading cause of disability worldwide. Based on recent studies suggesting within-individual dynamics, this article proposes that mental health and its underlying therapeutic mechanisms have underlying intrinsic dynamics that manifest across dimensions. Computational psychotherapy is needed to develop individual-specific pretreatment animated profiles of mental health. Such individual-specific animated profiles are expected to improve the ability to select the optimal treatment for each patient, devise adequate treatment plans, and adjust them on the basis of ongoing evaluations of mental-health dynamics, creating a new understanding of therapeutic change as a transition toward a more adaptive animated profile.
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20
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Wilhelm M, Moessner M, Jost S, Okon E, Malinowski V, Schinke K, Sommerfeld S, Bauer S. Development of decision rules for an adaptive aftercare intervention based on individual symptom courses for agoraphobia patients. Sci Rep 2024; 14:3056. [PMID: 38321070 PMCID: PMC10847472 DOI: 10.1038/s41598-024-52803-z] [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: 10/10/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
As other mental illnesses, agoraphobia is associated with a significant risk for relapse after the end of treatment. Personalized and adaptive approaches appear promising to improve maintenance treatment and aftercare as they acknowledge patients' varying individual needs with respect to intensity of care over time. Currently, there is a deficit of knowledge about the detailed symptom course after discharge from acute treatment, which is a prerequisite for the empirical development of rules to decide if and when aftercare should be intensified. Therefore, this study aimed firstly at the investigation of the naturalistic symptom course of agoraphobia after discharge from initial treatment and secondly at the development and evaluation of a data-driven algorithm for a digital adaptive aftercare intervention. A total of 56 agoraphobia patients were recruited in 3 hospitals. Following discharge, participants completed a weekly online monitoring assessment for three months. While symptom severity remained stable at the group level, individual courses were highly heterogeneous. Approximately two-thirds of the patients (70%) reported considerable symptoms at some time, indicating a need for medium or high-intense therapeutic support. Simulating the application of the algorithm to the data set resulted in an early (86% before week six) and relatively even allocation of patients to three groups (need for no, medium, and high-intense support respectively). Overall, findings confirm the need for adaptive aftercare strategies in agoraphobia. Digital, adaptive approaches may provide immediate support to patients who experience symptom deterioration and thus promise to contribute to an optimized allocation of therapeutic resources and overall improvement of care.
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Affiliation(s)
- Maximilian Wilhelm
- Center for Psychotherapy Research, Heidelberg University Hospital, Bergheimer Straße 54, 69115, Heidelberg, Germany
- Heidelberg University, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim/Heidelberg/Ulm, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, Heidelberg University Hospital, Bergheimer Straße 54, 69115, Heidelberg, Germany
| | - Silke Jost
- Median Zentrum für Verhaltensmedizin Bad Pyrmont, Median West GmbH, Berlin, Germany
| | - Eberhard Okon
- Median Zentrum für Verhaltensmedizin Bad Pyrmont, Median West GmbH, Berlin, Germany
| | - Volker Malinowski
- Median Zentrum für Verhaltensmedizin Bad Pyrmont, Median West GmbH, Berlin, Germany
| | - Katharina Schinke
- Median Parkklinik Bad Rothenfelde, Median Parkklinik Bad Rothenfelde GmbH, Berlin, Germany
| | | | - Stephanie Bauer
- Center for Psychotherapy Research, Heidelberg University Hospital, Bergheimer Straße 54, 69115, Heidelberg, Germany.
- German Center for Mental Health (DZPG), partner site Mannheim/Heidelberg/Ulm, Germany.
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21
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Blackwell SE. Using the 'Leapfrog' Design as a Simple Form of Adaptive Platform Trial to Develop, Test, and Implement Treatment Personalization Methods in Routine Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-023-01340-4. [PMID: 38316652 DOI: 10.1007/s10488-023-01340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/07/2024]
Abstract
The route for the development, evaluation and dissemination of personalized psychological therapies is complex and challenging. In particular, the large sample sizes needed to provide adequately powered trials of newly-developed personalization approaches means that the traditional treatment development route is extremely inefficient. This paper outlines the promise of adaptive platform trials (APT) embedded within routine practice as a method to streamline development and testing of personalized psychological therapies, and close the gap to implementation in real-world settings. It focuses in particular on a recently-developed simplified APT design, the 'leapfrog' trial, illustrating via simulation how such a trial may proceed and the advantages it can bring, for example in terms of reduced sample sizes. Finally it discusses models of how such trials could be implemented in routine practice, including potential challenges and caveats, alongside a longer-term perspective on the development of personalized psychological treatments.
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Affiliation(s)
- Simon E Blackwell
- Department of Clinical Psychology and Experimental Psychopathology, Georg-Elias-Mueller-Institute of Psychology, University of Göttingen, Kurze-Geismar-Str.1, 37073, Göttingen, Germany.
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Deisenhofer AK, Barkham M, Beierl ET, Schwartz B, Aafjes-van Doorn K, Beevers CG, Berwian IM, Blackwell SE, Bockting CL, Brakemeier EL, Brown G, Buckman JEJ, Castonguay LG, Cusack CE, Dalgleish T, de Jong K, Delgadillo J, DeRubeis RJ, Driessen E, Ehrenreich-May J, Fisher AJ, Fried EI, Fritz J, Furukawa TA, Gillan CM, Gómez Penedo JM, Hitchcock PF, Hofmann SG, Hollon SD, Jacobson NC, Karlin DR, Lee CT, Levinson CA, Lorenzo-Luaces L, McDanal R, Moggia D, Ng MY, Norris LA, Patel V, Piccirillo ML, Pilling S, Rubel JA, Salazar-de-Pablo G, Schleider JL, Schnurr PP, Schueller SM, Siegle GJ, Uher R, Watkins E, Webb CA, Wiltsey Stirman S, Wynants L, Youn SJ, Zilcha-Mano S, Lutz W, Cohen ZD. Implementing precision methods in personalizing psychological therapies: Barriers and possible ways forward. Behav Res Ther 2024; 172:104443. [PMID: 38086157 DOI: 10.1016/j.brat.2023.104443] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Claudi L Bockting
- AmsterdamUMC, Department of Psychiatry, Research Program Amsterdam Public Health and Centre for Urban Mental Health, University of Amsterdam, the Netherlands
| | | | | | | | | | | | | | - Kim de Jong
- Leiden University, Institute of Psychology, USA
| | | | | | | | | | | | | | - Jessica Fritz
- University of Cambridge, UK; Philipps University of Marburg, Germany
| | | | - Claire M Gillan
- School of Psychology, Trinity College Institute for Neuroscience, And Global Brain Health Institute, Trinity College Dublin, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Mei Yi Ng
- Florida International University, USA
| | | | | | | | | | | | | | - Jessica L Schleider
- Stony Brook University and Feinberg School of Medicine Northwestern University, USA
| | - Paula P Schnurr
- National Center for PTSD and Geisel School of Medicine at Dartmouth, USA
| | | | | | | | | | | | | | | | - Soo Jeong Youn
- Reliant Medical Group, OptumCare and Harvard Medical School, USA
| | | | | | - Zachary D Cohen
- University of California, Los Angeles and University of Arizona, USA.
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23
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Reuther C, Lundgren J, Gottvall M, Ljungberg J, Woodford J, von Essen L. E-therapists' views on the acceptability and feasibility of an internet-administered, guided, low-intensity cognitive behavioural therapy intervention for parents of children treated for cancer: A qualitative study. Digit Health 2024; 10:20552076241260513. [PMID: 38846368 PMCID: PMC11155313 DOI: 10.1177/20552076241260513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
Background Childhood cancer treatment completion can be a period of vulnerability for parents and is associated with mental health difficulties such as depression and anxiety. We developed an internet-administered, guided, low-intensity cognitive behavioural therapy-based self-help intervention (EJDeR) for parents delivered on the U-CARE-portal (Portal). The acceptability and feasibility of EJDeR and study procedures were examined using a single-arm feasibility trial (ENGAGE). Results indicated that EJDeR and ENGAGE study procedures are acceptable and feasible, however, a need for clinical and technical modifications to EJDeR and refinements to ENGAGE study procedures was identified. Objectives This study aimed to explore the acceptability and feasibility of EJDeR and ENGAGE study procedures from the perspective of e-therapists to inform clinical and technical modifications to EJDeR and refinements to study procedures prior to progression to a superiority randomised controlled trial. Methods We conducted semi-structured interviews with 10 e-therapists. Data were analysed using manifest content analysis. Results We identified three categories relating to the acceptability and feasibility of EJDeR: (a) Support to e-therapists (subcategories: Clinical supervision and Technical difficulties); (b) Guidance to parents (subcategories: Support protocols and Synchronous communication); and (c) Content (subcategories: Relevancy of the intervention and Pacing of the intervention). We identified four categories relating to the acceptability and feasibility of study procedures: (a) Recruitment and training of e-therapists (subcategories: Definition of the role and Training program); (b) Retention of parents (subcategories: Parent suitability and screening and Frequency of weekly Portal assessments); (c) Retention of e-therapists (subcategories: Administrative requirements and Communication with the research team); and (d) The Portal. Conclusions EJDeR and study procedures were considered acceptable and feasible, however, clinical and technical modifications and refinements to study procedures were suggested to enhance acceptability and feasibility. Results may also inform implementation considerations for both EJDeR and other similar digital psychological interventions. Trial registration number ISRCTN 57233429.
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Affiliation(s)
- Christina Reuther
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Johan Lundgren
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Maria Gottvall
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden
| | - Johan Ljungberg
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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24
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Williams NJ, Marcus SC, Ehrhart MG, Sklar M, Esp SM, Carandang K, Vega N, Gomes AE, Brookman-Frazee L, Aarons GA. Randomized Trial of an Organizational Implementation Strategy to Improve Measurement-Based Care Fidelity and Youth Outcomes in Community Mental Health. J Am Acad Child Adolesc Psychiatry 2023:S0890-8567(23)02239-6. [PMID: 38070868 PMCID: PMC11265517 DOI: 10.1016/j.jaac.2023.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/26/2023] [Accepted: 11/30/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Measurement-based care (MBC), which collects session-by-session symptom data from patients and provides clinicians with feedback on treatment response, is a highly generalizable evidence-based practice with significant potential to improve the outcomes of mental health treatment in youth when implemented with fidelity; however, it is rarely used in community settings. This study tested whether an implementation strategy targeting organizational leadership and organizational implementation climate could improve MBC fidelity and clinical outcomes for youth in outpatient mental health clinics. METHOD In a cluster randomized trial, 21 clinics were assigned to the Leadership and Organizational Change for Implementation strategy plus training and technical assistance in MBC (k = 11, n = 117) or training and technical assistance only (k = 10, n = 117). Primary outcomes of MBC fidelity (assessed via electronic metadata) and youth symptom improvement (assessed via caregiver-reported change on the Shortform Assessment for Children Total Problem Score) were collected for consecutively enrolled youths (ages 4-18 years) who initiated treatment in the 12 months following MBC training. Outcomes of each youth were assessed for 6 months following baseline. RESULTS A total of 234 youths were enrolled and included in intent-to-treat analyses. At baseline, there were no significant differences by condition in clinic, clinician, or youth characteristics. Youths in clinics using the Leadership and Organizational Change for Implementation strategy experienced significantly higher MBC fidelity compared with youths in control clinics (23.1% vs 3.4%, p = .014), and exhibited significantly greater reductions in symptoms from baseline to 6 months (d = 0.31, 95% CI: 0.04-0.58, p = .023). CONCLUSION Implementation strategies targeting organizational leadership and focused implementation climate can improve fidelity to evidence-based practices and clinical outcomes of youth mental health services. CLINICAL TRIAL REGISTRATION INFORMATION Working to Implement and Sustain Digital Outcome Measures (WISDOM); https://clinicaltrials.gov/; NCT04096274.
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25
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Solstad SM, Cooper M, Sundet R, Moltu C. Effects and experiences of idiographic patient-reported outcome measures for feedback in psychotherapy: A systematic review and secondary analysis of the empirical literature. Psychother Res 2023:1-14. [PMID: 37990817 DOI: 10.1080/10503307.2023.2283528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
Objective: There is a growing interest in idiographic patient-reported outcome measures (I-PROMs) for routine outcome monitoring (ROM) and clinical feedback (CF) in psychotherapy, but to our knowledge, no systematic reviews of the empirical literature. Method: We conducted a systematic literature search for empirical papers investigating effects and experiences of I-PROMs for ROM/CF and found a total of 13 papers. There was only one experimental controlled effectiveness study. Results: We formulated a narrative summary of the data set as a whole. We conducted a secondary analysis of nine papers containing qualitative data on stakeholder experiences with I-PROMs and found three superordinate themes and eight subthemes, summarized as "I-PROMs can facilitate self-reflection for patients, assist in identifying and tracking therapeutic topics, and make patients more committed to therapy by giving them a greater sense of responsibility and empowerment. Formulating goals and problems can be difficult, and lack of progress can be demotivating. Time in therapy is precious and must be spent wisely. Effective use of I-PROMs is facilitated by flexibility and therapists' use of clinical skills." Conclusion: We discuss the limitations of the study and provide recommendations for future research and clinical practice.
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Affiliation(s)
| | - Mick Cooper
- School of Psychology, University of Roehampton, London, UK
| | - Rolf Sundet
- University of South-Eastern Norway, Borre, Norway
| | - Christian Moltu
- District General Hospital of Førde, Førde, Norway
- Western Norway University College of Applied Sciences, Førde, Norway
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26
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Douglas S, Bovendeerd B, van Sonsbeek M, Manns M, Milling XP, Tyler K, Bala N, Satterthwaite T, Hovland RT, Amble I, Atzil-Slonim D, Barkham M, de Jong K, Kendrick T, Nordberg SS, Lutz W, Rubel JA, Skjulsvik T, Moltu C. A Clinical Leadership Lens on Implementing Progress Feedback in Three Countries: Development of a Multidimensional Qualitative Coding Scheme. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01314-6. [PMID: 37917313 DOI: 10.1007/s10488-023-01314-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Progress feedback, also known as measurement-based care (MBC), is the routine collection of patient-reported measures to monitor treatment progress and inform clinical decision-making. Although a key ingredient to improving mental health care, sustained use of progress feedback is poor. Integration into everyday workflow is challenging, impacted by a complex interrelated set of factors across patient, clinician, organizational, and health system levels. This study describes the development of a qualitative coding scheme for progress feedback implementation that accounts for the dynamic nature of barriers and facilitators across multiple levels of use in mental health settings. Such a coding scheme may help promote a common language for researchers and implementers to better identify barriers that need to be addressed, as well as facilitators that could be supported in different settings and contexts. METHODS Clinical staff, managers, and leaders from two Dutch, three Norwegian, and four mental health organizations in the USA participated in semi-structured interviews on how intra- and extra-organizational characteristics interact to influence the use of progress feedback in clinical practice, supervision, and program improvement. Interviews were conducted in the local language, then translated to English prior to qualitative coding. RESULTS A team-based consensus coding approach was used to refine an a priori expert-informed and literature-based qualitative scheme to incorporate new understandings and constructs as they emerged. First, this hermeneutic approach resulted in a multi-level coding scheme with nine superordinate categories and 30 subcategories. Second-order axial coding established contextually sensitive categories for barriers and facilitators. CONCLUSIONS The primary outcome is an empirically derived multi-level qualitative coding scheme that can be used in progress feedback implementation research and development. It can be applied across contexts and settings, with expectations for ongoing refinement. Suggestions for future research and application in practice settings are provided. Supplementary materials include the coding scheme and a detailed playbook.
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Affiliation(s)
- Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA.
| | - Bram Bovendeerd
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
- Dimence, Center for Mental Health Care, Deventer, the Netherlands
| | | | - Mya Manns
- Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA
| | - Xavier Patrick Milling
- Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA
| | - Ke'Sean Tyler
- Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA
| | | | - Tim Satterthwaite
- Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA
| | - Runar Tengel Hovland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Research and Innovation, Førde Hospital Trust, Førde, Norway
| | - Ingunn Amble
- Villa Sana - Centre for Work Health, Modum Bad, Norway
| | | | - Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Kim de Jong
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Tony Kendrick
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Samuel S Nordberg
- Department of Behavioral Health, Reliant Medical Group, Worcester, MA, USA
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Julian A Rubel
- Department of Psychology, Psychotherapy Research Lab, Justus Liebig University Giessen, Giessen, Germany
| | | | - Christian Moltu
- District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway
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