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Letourneau N, McManus C, Novick J, Silverstone A. Impacts of Peer Support on Coping and Cortisol Levels for Women Affected by Domestic Violence and Coercive Control. Can J Nurs Res 2024:8445621241272723. [PMID: 39149993 DOI: 10.1177/08445621241272723] [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: 08/17/2024] Open
Abstract
PURPOSE Gendered domestic violence and coercive control are prevalent public heath concerns in Canada with dire consequences for survivors. Peer support groups may address and reduce negative impacts of domestic violence and coercive control on women's stress, coping, safety, and alliances with social support network members, the focus of this study. METHODS A one-group, pre-test/post-test quasi-experimental study was undertaken to evaluate the effectiveness of Growth Circle, a 14-week peer support program offered at an agency serving women affected by domestic violence in a major western Canadian city. Through convenience sampling, women 18 years and older who experienced domestic violence were recruited and provided data on stress, coping, safety-related empowerment, and social support/alliances. Thirty-five participants provided all pre-test and post-test data, with a subsample of 14 providing repeated hair samples. Hair was employed to determine stress hormone (cortisol) levels. RESULTS A significant reduction in self-reported levels of perceived stress and stress hormone levels following completion of the Growth Circle program was revealed. Participants also reported a significant increase in safety-related empowerment, and supportive alliances with group members. CONCLUSIONS The Growth Circle peer support program was demonstrated to be effective. Further implementation and research into the Growth Circle program across Canada is recommended.
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Affiliation(s)
- Nicole Letourneau
- Professor, Faculty of Nursing and Cumming School of Medicine (Pediatrics, Psychiatry, Community Health Sciences), University of Calgary, Calgary, Alberta, Canada, T2N 1N4
| | - Carrie McManus
- Director of Innovation and Programs, Sagesse Domestic Violence Prevention Society, Calgary, Alberta, Canada
| | - Jason Novick
- Research Assistant, Cumming School of Medicine (Pediatrics), University of Calgary, Calgary, Alberta, Canada, T2N 1N4
| | - Andrea Silverstone
- Chief Executive Officer, Sagesse Domestic Violence Prevention Society, Calgary, Alberta, Canada
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McCall HC, Hadjistavropoulos HD. Impact of an Online Discussion Forum on Self-Guided Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Randomized Trial. J Med Internet Res 2024; 26:e59699. [PMID: 39141899 DOI: 10.2196/59699] [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: 04/19/2024] [Revised: 06/26/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Internet-delivered cognitive behavioral therapy (ICBT) is an effective and accessible treatment for various mental health concerns. ICBT has shown promising treatment outcomes among public safety personnel (PSP), who experience high rates of mental health problems and face barriers to accessing other mental health services. Client engagement and clinical outcomes are better in ICBT with therapist guidance, but ICBT is easier to implement on a large scale when it is self-guided. Therefore, it is important to identify strategies to improve outcomes and engagement in self-guided ICBT and other self-guided digital mental health interventions. One such strategy is the use of online discussion forums to provide ICBT clients with opportunities for mutual social support. Self-guided interventions accompanied by online discussion forums have shown excellent treatment outcomes, but there is a need for research experimentally testing the impact of online discussion forums in ICBT. OBJECTIVE We aimed to evaluate a transdiagnostic, self-guided ICBT intervention tailored specifically for PSP (which had not previously been assessed), assess the impact of adding a therapist-moderated online discussion forum on outcomes, and analyze participants' feedback to inform future research and implementation efforts. METHODS In this randomized trial, we randomly assigned participating PSP (N=107) to access an 8-week transdiagnostic, self-guided ICBT course with or without a built-in online discussion forum. Enrollment and participation were entirely web-based. We assessed changes in depression, anxiety, and posttraumatic stress as well as several secondary outcome measures (eg, treatment engagement and satisfaction) using questionnaires at the pre-enrollment, 8-week postenrollment, and 20-week postenrollment time points. Mixed methods analyses included multilevel modeling and qualitative content analysis. RESULTS Participants engaged minimally with the forum, creating 9 posts. There were no differences in treatment outcomes between participants who were randomly assigned to access the forum (56/107, 52.3%) and those who were not (51/107, 47.7%). Across conditions, participants who reported clinically significant symptoms during enrollment showed large and statistically significant reductions in symptoms (P<.05 and d>0.97 in all cases). Participants also showed good treatment engagement and satisfaction, with 43% (46/107) of participants fully completing the intervention during the course of the study and 96% (79/82) indicating that the intervention was worth their time. CONCLUSIONS Previous research has shown excellent clinical outcomes for self-guided ICBT accompanied by discussion forums and good engagement with those forums. Although clinical outcomes in our study were excellent across conditions, engagement with the forum was poor, in contrast to previous research. We discuss several possible interpretations of this finding (eg, related to the population under study or the design of the forum). Our findings highlight a need for more research evaluating the impact of online discussion forums and other strategies for improving outcomes and engagement in self-guided ICBT and other digital mental health interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT05145582; https://clinicaltrials.gov/study/NCT05145582.
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Affiliation(s)
- Hugh C McCall
- Department of Psychology, University of Regina, Regina, SK, Canada
- PSPNET, University of Regina, Regina, SK, Canada
| | - Heather D Hadjistavropoulos
- Department of Psychology, University of Regina, Regina, SK, Canada
- PSPNET, University of Regina, Regina, SK, Canada
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Tymofiyeva O, Sipes BS, Luks T, Hamlat EJ, Samson TE, Hoffmann TJ, Glidden DV, Jakary A, Li Y, Ngan T, Henje E, Yang TT. Interoceptive brain network mechanisms of mindfulness-based training in healthy adolescents. Front Psychol 2024; 15:1410319. [PMID: 39193038 PMCID: PMC11348390 DOI: 10.3389/fpsyg.2024.1410319] [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: 03/31/2024] [Accepted: 07/18/2024] [Indexed: 08/29/2024] Open
Abstract
Introduction This study evaluated changes in the white matter of the brain and psychological health variables, resulting from a neuroscience-based mindfulness intervention, the Training for Awareness, Resilience, and Action (TARA), in a population of healthy adolescents. Methods A total of 100 healthy adolescents (57 female, age ranges 14-18 years) were randomized into the 12-week TARA intervention or a waitlist-control group. All participants were imaged with diffusion MRI to quantify white matter connectivity between brain regions. Imaging occurred at baseline/randomization and after 12 weeks of baseline (pre- and post-intervention in the TARA group). We hypothesized that structural connectivity in the striatum and interoceptive networks would increase following the TARA intervention, and that, this increased connectivity would relate to psychological health metrics from the Strengths and Difficulties Questionnaire (SDQ) and the Insomnia Severity Index (ISI). The TARA intervention and all assessments, except for the MRIs, were fully remotely delivered using secure telehealth platforms and online electronic data capture systems. Results The TARA intervention showed high consistency, tolerability, safety, recruitment, fidelity, adherence, and retention. After 12 weeks, the TARA group, but not controls, also demonstrated significantly improved sleep quality (p = 0.02), and changes in the right putamen node strength were related to this improved sleep quality (r = -0.42, p = 0.006). Similarly, the TARA group, but not controls, had significantly increased right insula node strength related to improved emotional well-being (r = -0.31, p = 0.04). Finally, we used the network-based statistics to identify a white matter interoception network that strengthened following TARA (p = 0.009). Discussion These results suggest that the TARA mindfulness-based intervention in healthy adolescents is feasible and safe, and it may act to increase structural connectivity strength in interoceptive brain regions. Furthermore, these white matter changes are associated with improved adolescent sleep quality and emotional well-being. Our results suggest that TARA could be a promising fully remotely delivered intervention for improving psychological well-being in adolescents. As our findings suggest that TARA affects brain regions in healthy adolescents, which are also known to be altered during depression in adolescents, future studies will examine the effects of TARA on depressed adolescents. Clinical trial registration https://clinicaltrials.gov/study/NCT04254796.
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Affiliation(s)
- Olga Tymofiyeva
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Benjamin S. Sipes
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Tracy Luks
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Elissa J. Hamlat
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Langley Porter Psychiatric Institute, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Tara E. Samson
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Thomas J. Hoffmann
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Angela Jakary
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Yi Li
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Tiffany Ngan
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Eva Henje
- Department of Clinical Science/Child- and Adolescent Psychiatry, Umeå University, Umeå, Sweden
| | - Tony T. Yang
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Langley Porter Psychiatric Institute, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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Hesselmans S, Meiland FJM, Adam E, van de Cruijs E, Vonk A, van Oost F, Dillen D, de Vries S, Riegen E, Smits R, de Knegt N, Smaling HJA, Meinders ER. Effect of stress-based interventions on the quality of life of people with an intellectual disability and their caregivers. Disabil Rehabil Assist Technol 2024; 19:2198-2206. [PMID: 38037304 DOI: 10.1080/17483107.2023.2287161] [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: 12/21/2022] [Revised: 11/03/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE People with intellectual disabilities often show challenging behaviour, which can manifest itself in self-harm or aggression towards others. Real-time monitoring of stress in clients with challenging behaviour can help caregivers to promptly deploy interventions to prevent escalations, ultimately to improve the quality of life of client and caregiver. This study aimed to assess the impact of real-time stress monitoring with HUME, and the subsequent interventions deployed by the care team, on stress levels and quality of life. MATERIALS AND METHODS Real-time stress monitoring was used in 41 clients with intellectual disabilities in a long-term care setting over a period of six months. Stress levels were determined at the start and during the deployment of the stress monitoring system. The quality of life of the client and caregiver was measured with the Outcome Rating Scale at the start and at three months of use. RESULTS The results showed that the HUME-based interventions resulted in a stress reduction. The perceived quality of life was higher after three months for both the clients and caregivers. Furthermore, interventions to provide proximity were found to be most effective in reducing stress and increasing the client's quality of life. CONCLUSIONS The study demonstrates that real-time stress monitoring with the HUME and the following interventions were effective. There was less stress in clients with an intellectual disability and an increase in the perceived quality of life. Future larger and randomized controlled studies are needed to confirm these findings.
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Affiliation(s)
| | - Franka J M Meiland
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Medicine for Older People, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Esmee Adam
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- University Network of the Care Sector Zuid Holland, Leiden, The Netherlands
| | | | | | | | | | | | | | | | - Nanda de Knegt
- Prinsenstichting, Care Center for People with Intellectual Disabilities, Purmerend, The Netherlands
| | - Hanneke J A Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- University Network of the Care Sector Zuid Holland, Leiden, The Netherlands
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Graham F, Williman J, Desha L, Snell D, Jones B, Ingham T, Latu ATF, Ranta A, Walker E, Makasini S, Ziviani J. Realist process evaluation of occupational performance coaching: protocol. BMJ Open 2024; 14:e075727. [PMID: 38844396 PMCID: PMC11163826 DOI: 10.1136/bmjopen-2023-075727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/26/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION A cluster randomised controlled trial, the Meaning, Agency and Nurturing Autonomy (MANA) study, is underway comparing the effects of occupational performance coaching (OPC) and usual care on the social participation, health and well-being of children with neurodisability and their caregivers. This protocol presents the realist process evaluation which is occurring in parallel with the trial to allow testing and further refinement of OPC programme theory, as represented in its logic model. The aim of this realist evaluation is to examine what works, for whom, in the implementation of OPC with caregivers of children with neurodisability (in particular, Māori and Pasifika) in current service delivery contexts. METHODS AND ANALYSIS Guided by OPC programme theory and realist evaluation processes, mixed-methods data collected from the MANA study OPC group will be analysed to elucidate when OPC works (outcomes), for whom, how (mechanisms) and under what circumstances (contexts). This will culminate in the synthesis of Intervention-Actor Context-Mechanism-Outcome configurations. Descriptive analyses will be reported for quantitative measures of treatment fidelity (OPC-Fidelity Measure), caregiver emotional response to OPC (Session Rating Scale) preintervention emotional state (Depression Stress and Anxiety Scale) and client outcomes (Canadian Occupational Performance Measure). Reflexive thematic analysis will be undertaken to analyse realist interviews with therapists who implemented OPC above and below fidelity thresholds and culturally focused interviews with clients of Māori or Pasifika ethnicity, informing understanding of the contexts influencing therapists' implementation of OPC with fidelity, and the mechanisms triggered within therapists or caregivers to elicit a response to the intervention. The MANA study trial outcomes will be reported separately. ETHICS AND DISSEMINATION Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee (20/STH/93). In all participating jurisdictions local area approval was obtained, involving a process of local Māori consultation. Results will be disseminated to all participants, and more broadly to clinicians and policy-makers through conference presentations and peer-reviewed journal publications, which will inform decision-making about resourcing and supporting effective delivery of OPC to optimise outcomes for children and caregivers. TRIAL REGISTRATION NUMBER ACTRN12621000519853.
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Affiliation(s)
- Fiona Graham
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jonathan Williman
- Public Health and General Practice, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
| | - Laura Desha
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - Bernadette Jones
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Tristram Ingham
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Emma Walker
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Salote Makasini
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jenny Ziviani
- The University of Queensland - Saint Lucia Campus, Saint Lucia, Queensland, Australia
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Li E, Kealy D, Aafjes-van Doorn K, McCollum J, Curtis JT, Luo X, Silberschatz G. "It Felt Like I Was Being Tailored to the Treatment Rather Than the Treatment Being Tailored to Me": Patient Experiences of Helpful and Unhelpful Psychotherapy. Psychother Res 2024:1-15. [PMID: 38833539 DOI: 10.1080/10503307.2024.2360448] [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: 01/03/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE This qualitative study explores patients' experiences of psychotherapy, focusing on elements perceived as helpful or unhelpful and suggestions for improvement in the context of public mental health care. METHODS A total of 148 adults (Mean age = 32.24, SD = 9.92) who had been or are currently receiving psychological treatment from the National Health Service (NHS) responded to an online survey. The survey included open-ended questions regarding their experiences of psychotherapy, asking them to identify helpful or unhelpful aspects, and suggestions for improvement. Using thematic analysis, key themes were identified. RESULTS The analysis highlighted the patient's preference for personalized treatment, the importance of therapeutic alliance, the demand for depth in therapy, and life skills and agency as therapeutic outcomes. Participants suggested improvements such as more tailored approaches and stronger therapist-patient relationships, supporting an adaptable, patient-centered model. CONCLUSION The study highlights challenges in public mental health services where patients might feel their specific needs are not being recognized and met and underscores the importance of personalized treatment plans that satisfy and evolve with patient needs, suggesting that therapists must be attentive and responsive to individual desires to enhance the patient experience.
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Affiliation(s)
- Elizabeth Li
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud Centre, London, UK
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - James McCollum
- San Francisco Psychotherapy Research Group, San Francisco, CA, USA
| | - John T Curtis
- San Francisco Psychotherapy Research Group, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, USA
| | - George Silberschatz
- San Francisco Psychotherapy Research Group, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
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Dandachi-FitzGerald B, Houben STL, Broers NJ, Merckelbach H. A Scale for Measuring Positive and Negative Experiences of Psychotherapy (PNEP): First Psychometric Findings of a New Instrument for Monitoring Clients' Experiences. Clin Psychol Psychother 2024; 31:e3014. [PMID: 38837842 DOI: 10.1002/cpp.3014] [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: 12/07/2023] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Clients' adverse experiences during psychotherapy are rarely monitored in clinical practice or research trials. One obstacle here is the lack of a measure to gauge both positive and negative experiences during psychotherapy. We developed and evaluated a new instrument for measuring such experiences. METHOD The Positive and Negative Experiences of Psychotherapy (PNEP) questionnaire was developed based on pilot data, a literature review, and two existing scales for measuring primarily adverse experiences during psychotherapy. Mental healthcare clients (N = 200) anonymously completed and evaluated the PNEP. Subsequently, a sample of professionals (N = 34) who underwent psychotherapy in the context of their training filled in the PNEP twice, with a 2-week interval in between. RESULTS The positive and negative experiences subscales of the PNEP were found to possess excellent internal consistencies (αs ≥ 0.90). The PNEP test-retest reliability was 0.93 for the positive experiences subscale and 0.78 for the negative experiences subscale. For the positive subscale, four factors were extracted: symptom reduction and positive well-being, high quality of therapy and therapeutic relation, personal growth and acceptance and interpersonal functioning. For the negative subscale, exploratory factor analysis suggested a three-factor solution: escalation of symptoms and emotional distress, low quality of therapy and therapeutic relation and (self-)stigmatization and dependency. Participants related a median of 13 positive and six negative therapy experiences to their most recent treatment. The most frequently endorsed negative experiences were having more negative thoughts and memories, feeling emotionally overwhelmed and an increase in stress due to the therapy. A minority of participants (10.5%) reported no negative treatment experiences. CONCLUSIONS In the field of psychotherapy, the evaluation of risks and benefits is crucial for assessing safety and effectiveness. The PNEP could be a promising instrument for achieving this objective, although further research is needed to replicate and expand upon the current findings.
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Affiliation(s)
| | - Sanne T L Houben
- Universiteit Maastricht Faculty of Psychology and Neuroscience, Maastricht, Netherlands
| | - Nick J Broers
- Universiteit Maastricht Faculty of Psychology and Neuroscience, Maastricht, Netherlands
| | - Harald Merckelbach
- Universiteit Maastricht Faculty of Psychology and Neuroscience, Maastricht, Netherlands
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Chessell C, Halldorsson B, Walters S, Farrington A, Harvey K, Creswell C. Therapist guided, parent-led cognitive behavioural therapy (CBT) for pre-adolescent children with obsessive compulsive disorder (OCD): a non-concurrent multiple baseline case series. Behav Cogn Psychother 2024; 52:243-261. [PMID: 37840150 DOI: 10.1017/s1352465823000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) including exposure and response prevention (ERP) is an effective treatment for preadolescent children with obsessive compulsive disorder (OCD); however, there is a need to increase access to this treatment for affected children. AIMS This study is a preliminary evaluation of the efficacy and acceptability of a brief therapist-guided, parent-led CBT intervention for pre-adolescent children (5-12 years old) with OCD using a non-concurrent multiple baseline approach. METHOD Parents of 10 children with OCD were randomly allocated to no-treatment baselines of 3, 4 or 5 weeks before receiving six to eight individual treatment sessions with a Psychological Wellbeing Practitioner. Diagnostic measures were completed prior to the baseline, 1-week post-treatment, and at a 1-month follow-up, and parents completed weekly measures of children's OCD symptoms/impairment. RESULTS Seventy percent of children were 'responders' and/or 'remitters' on diagnostic measures at post-treatment, and 60% at the 1-month follow-up. At least 50% of children showed reliable improvements on parent-reported OCD symptoms/impairment from pre- to post-treatment, and from pre-treatment to 1-month follow-up. Crucially, the intervention was acceptable to parents. CONCLUSIONS Brief therapist-guided, parent-led CBT has the potential to be an effective, acceptable and accessible first-line treatment for pre-adolescent children with OCD, subject to the findings of further evaluations.
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Affiliation(s)
- Chloe Chessell
- School of Psychological and Clinical Language Sciences, University of Reading, UK
- Department of Experimental Psychology, University of Oxford, UK
- Department of Psychiatry, University of Oxford, UK
| | - Brynjar Halldorsson
- Department of Psychology, Reykjavik University, Iceland
- Landspitali, The National University Hospital of Iceland, Iceland
- Department of Experimental Psychology, University of Oxford, UK
- Department of Psychiatry, University of Oxford, UK
| | - Sasha Walters
- National Specialist CAMHS OCD, BDD, and Related Disorders Team, London, UK
- Oxford Psychological Intervention Centre, Oxford, UK
| | - Alice Farrington
- CAMHS Anxiety and Depression Pathway, Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Kate Harvey
- School of Psychological and Clinical Language Sciences, University of Reading, UK
| | - Cathy Creswell
- Department of Experimental Psychology, University of Oxford, UK
- Department of Psychiatry, University of Oxford, UK
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Vitry G, Pakrosnis R, Jackson JB, Gallin E, Hoyt MF. Problem resolution scale: A single-item instrument for easily assessing clinical improvement. JOURNAL OF MARITAL AND FAMILY THERAPY 2024; 50:477-494. [PMID: 38327170 DOI: 10.1111/jmft.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
This study describes the development and tests the validity of the Problem Resolution Scale (PRS)-a single-item measure developed by researchers at Systemic Practice Research Network (SYPRENE) for assessing the degree to which the focal problem of therapy is perceived as resolved. Data were collected at termination from 747 clients seen across 18 therapists. Results suggested good construct validity, supported by a strong correlation between client and therapist perceptions as assessed by the PRS (r = 0.71, p < 0.001). Good criterion validity was also supported by strong correlations between client-reported psychological well-being and functioning at termination and both client-reported (r = -0.63; p < 0.001) and therapist-reported (r = -0.66; p < 0.001) problem resolution scores. Linear mixed model regression and stratified correlation analysis controlling for the therapist and presenting problem effects confirmed criterion validity. Results provide initial evidence for the validity and utility of the PRS.
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Affiliation(s)
- Grégoire Vitry
- LACT, Paris, France, University Paris Descartes, Paris, France
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10
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Dowell A, Stubbe M, Dunlop A, Fedchuck D, Gardiner T, Garrett S, Gordon S, Hilder J, Mathieson F, Tester R. Evaluating Success and Challenges of a Primary Care Youth Mental Health Programme Using Complexity, Implementation Science, and Appreciative Inquiry. Cureus 2024; 16:e58870. [PMID: 38800160 PMCID: PMC11116841 DOI: 10.7759/cureus.58870] [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] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Background Using an innovative framework of complexity and implementation science, with underpinning core values of appreciative inquiry (CIS-A), this paper describes the evaluation of a pilot service in New Zealand aiming to deliver integrated psychological therapy services within primary care, to young people (aged 18-24) experiencing mild to moderate mental distress. Method Using mixed quantitative and qualitative methods and multiple data sources, there was a strong focus on local innovation and co-design with service users, young people and multiple care providers. Data is drawn from service users, stakeholders and providers of the service in three areas of the lower North Island of New Zealand. Results The Piki pilot provided a significant and innovative enhancement of mental health care to this population. The service supported 5307 individuals with a range of therapy options, with the majority having between one and three therapy sessions. From 730 service users who completed a survey, 591 (81%) were 'very satisfied' with the service provided. The CIS-A framework was used successfully to provide rapid feedback and encourage adaptation to evolving issues. These included unexpected workload pressures, changes to therapy delivery, the integration of co-design and prioritising the needs of vulnerable groups. There was a successful incorporation of youth/service user input to co-design the programme, introduction of a peer-to-peer support service, and integration of a digital resource platform. The framework was also used to address challenges encountered and to support necessary adaptations in response to the COVID-19 pandemic. Conclusions We describe the use of an embedded evaluation to support and inform the implementation of a novel and innovative youth mental health programme. Complexity and implementation science, underpinned by the core values of appreciative inquiry (CIS-A), were successfully utilised providing potential learning that can be applied locally, nationally and internationally. This study has a focus on youth mental health but the principles and utility of applying a complexity and implementation science approach have application in many different health care settings. The use of a framework such as CIS-A can support complex innovation and implementation and can be used to enable rapid course correction and turn 'hindsight to foresight'.
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Affiliation(s)
- Anthony Dowell
- Primary Health Care and General Practice, University of Otago, Wellington, NZL
| | - Maria Stubbe
- Primary Health Care and General Practice, University of Otago, Wellington, NZL
| | - Abigail Dunlop
- Primary Health Care and General Practice, University of Otago, Wellington, NZL
| | - Dasha Fedchuck
- Psychological Medicine, University of Otago, Wellington, NZL
| | - Tracey Gardiner
- Psychological Medicine, University of Otago, Wellington, NZL
| | - Sue Garrett
- Primary Health Care and General Practice, University of Otago, Wellington, NZL
| | - Sarah Gordon
- Psychological Medicine, University of Otago, Wellington, NZL
| | - Jo Hilder
- Primary Health Care and General Practice, University of Otago, Wellington, NZL
| | - Fiona Mathieson
- Psychological Medicine, University of Otago, Wellington, NZL
| | - Rachel Tester
- Primary Health Care and General Practice, University of Otago, Wellington, NZL
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11
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Graham FP, Williman JA, Desha LN, Snell D, Jones B, Ingham TR, Latu A, Maggo JK, Ranta A, Ziviani J. Occupational Performance Coaching for Children With Neurodisability: A Randomized Controlled Trial Protocol. Can J Occup Ther 2024; 91:4-16. [PMID: 36919383 PMCID: PMC10903119 DOI: 10.1177/00084174231160976] [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] [Indexed: 03/16/2023]
Abstract
Background. Occupational Performance Coaching (OPC) is a goal-oriented approach in which client agency takes precedence in goal selection, analysis, choice of action, and evaluation of success. The intended outcomes of OPC are improved occupational performance and participation in clients' life situations. Randomized clinical trials are needed to determine the effectiveness of OPC. Purpose. This study protocol outlines a randomized controlled trial (RCT) of OPC compared to usual care with caregivers of children with neurodisability in improving child, caregiver, and family occupational performance. Method. A single-blind, 2-arm parallel-group, cluster RCT of OPC compared to usual care is planned. Therapists delivering the intervention (N = 14) are randomized to "OPC training" or "usual care" groups. The primary outcome is occupational performance improvement in caregiver (N = 84) identified goals. Implications. Findings will provide translational evidence of the effectiveness of OPC and clarify intervention processes. Areas of future OPC research and development will be indicated.
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Affiliation(s)
- Fiona P. Graham
- Fiona P. Graham, Rehabilitation Teaching and Research Unit, University of Otago Wellington, 23A Mein Street, Newtown, Wellington 6242, New Zealand. Phone: ++64 364 3620.
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12
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Redmayne KA, Reese RJ, Zetzer HA, Conoley CW, Owen J. Do routine outcome monitoring measures tell the same story? Evaluating outcome trajectories and clinical outcomes for the outcome rating scale and outcome questionnaire - 45. Psychother Res 2024; 34:195-204. [PMID: 36931233 DOI: 10.1080/10503307.2023.2181113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/09/2023] [Indexed: 03/19/2023] Open
Abstract
Routine outcome monitoring (ROM) of psychotherapy improves client outcomes and reduces premature terminations. Two ROM systems with the most empirical support are the OQ System (Lambert, 2010) and the Partners for Change Outcome Management System (PCOMS; Duncan, 2012; Miller et al., 2005). We evaluated if the global distress measures, the Outcome Rating Scale (ORS; PCOMS) and the Outcome Questionnaire-45.2 (OQ-45; OQ System) show similar outcome trajectories and rates of reliable and clinically significant change when completed by the same clients. Participants (N = 290) were clients from archived data collected in a training clinic for a psychology doctoral program in the western United States, who completed both the ORS and OQ-45 across treatment. Bi-variate correlations between the ORS and OQ-45 were highly correlated at the first session (r = -.73), and for later sessions linear and quadratic estimates were only moderately related (rs = -.31 to -.57). Statistically significantly more clients indicated both reliable change and clinically significant change on the ORS compared to the OQ-45. The results indicate that these measures are correlated but not interchangeable in relation to the conclusions they generate about treatment outcomes. Measurement tools should be carefully considered given the potential for different conclusions to be drawn regarding treatment progress and outcomes.
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Affiliation(s)
- K A Redmayne
- Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - R J Reese
- Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, AL, USA
| | - H A Zetzer
- Carol Ackerman Positive Psychology Clinic, University of California Santa Barbara, Santa Barbara, CA, USA
| | - C W Conoley
- Psychology, California State University Long Beach, Long Beach, CA, USA
| | - J Owen
- Counseling Psychology, University of Denver, Denver, CO, USA
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13
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Wan-Vermeer R, Bouwmeester S, Starrenburg A. Brief individual experiential schema therapy in adult outpatients with cluster C personality disorders: Does it work? Clin Psychol Psychother 2024; 31:e2948. [PMID: 38343344 DOI: 10.1002/cpp.2948] [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: 11/07/2022] [Revised: 10/30/2023] [Accepted: 12/11/2023] [Indexed: 02/15/2024]
Abstract
This study investigated the effectiveness of brief individual experiential schema therapy (ST) in 12 adult outpatients with cluster C personality disorders (PD) using randomised multiple baseline design. Waitlist period was followed by five explorative sessions, 18 experiential ST sessions, two treatment follow-up (FU) booster sessions and a 6-month FU assessment. Overall well-being (ORS), behavioural treatment goals and negative core beliefs were assessed 60-91 times, global symptomatic distress (BSI) six times. PD severity (SCID-5-PD) was pre-post-analysed. Randomisation and non-parametric tests showed large significant effects (d = 1.08-2.38, r = .53-.66) on all outcomes at treatment-FU and 6-month FU assessment. This is the first study providing preliminary evidence of effectiveness of brief individual experiential ST for patients with cluster C PD, tentatively challenging the common tenet that long treatment duration is required. Due to limitations, replication is recommended.
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14
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Bøhle K, Otterholt E, Bjørkly SK. A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment. Subst Abuse Rehabil 2023; 14:61-75. [PMID: 37465017 PMCID: PMC10351681 DOI: 10.2147/sar.s376389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 05/02/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction This prospective, repeated-measures observational study tested biopsychosocial variables as risk factors for dropping out of inpatient substance addiction treatment. Substance use disorder (SUD) is viewed as a chronic relapsing disease caused by an interaction between biological, psychological, and social factors. However, there is a lack of prospective studies that combine biopsychosocial variables when assessing dropout. The aims of this study were to investigate whether there was 1) An association between biopsychosocial factors and dropping out of inpatient substance addiction treatment, 2) An interaction with SUD diagnosis and cortisol, and 3) Different dropout rates between short-term and long-term institutions. Materials and Methods Patients (n = 173) were recruited from two inpatient treatment centers in Norway between 2018 and 2021. The following biopsychosocial variables were measured at four timepoints: ward atmosphere (Ward Atmosphere Scale, WAS), psychological distress (Hopkins Symptom Checklist 10, HSCL-10), motivation (M-scale of the Circumstances, Motivation, Readiness, and Suitability questionnaire), and concentration of salivary cortisol (CORT- nmol/L). Cortisol levels were measured for two consecutive days at each timepoint and calculated by two cortisol indices, daytime cortisol slope (DCS) and area under the curve with respect to the ground (AUCG). A multivariate logistic regression analysis was performed to find an association between dropout rates and the biopsychosocial variables. Results The results suggest a lower dropout odds for patients with high motivation (OR = 0.76, p = 0.022) and patients admitted to short-term treatment (OR = 0.06, p = 0.005). An interaction with stimulant SUD and DCS (OR = 13.74, p = 0.024) also revealed higher dropout odds. No statistical significance was found for psychological distress, WAS, and cortisol AUCG. Conclusion The results support monitoring motivation during treatment and further investigating biopsychosocial variables when assessing dropout risk together with SUD diagnosis.
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Affiliation(s)
- Kari Bøhle
- Faculty of Health and Social Science, Molde University College, Molde, Norway
- Clinic of Mental Health and Addiction, Møre and Romsdal Hospital Trust, Molde, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eli Otterholt
- Faculty of Health and Social Science, Molde University College, Molde, Norway
- Clinic of Mental Health and Addiction, Møre and Romsdal Hospital Trust, Molde, Norway
| | - Stål Kapstø Bjørkly
- Faculty of Health and Social Science, Molde University College, Molde, Norway
- Regional Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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15
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Cruwys T, Lee GC, Robertson AM, Haslam C, Sterling N, Platow MJ, Williams E, Haslam SA, Walter ZC. Therapists who foster social identification build stronger therapeutic working alliance and have better client outcomes. Compr Psychiatry 2023; 124:152394. [PMID: 37216806 DOI: 10.1016/j.comppsych.2023.152394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/08/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND For decades we have known that therapeutic working alliance is a key contributor to client engagement and positive outcomes in therapy. However, we have made little progress in narrowing down its determinants, which is critical in supporting trainees to optimize such alliance. We make a case for the value of incorporating social psychological frameworks into models of alliance and explore the role of social identity processes in the development of therapeutic alliance. METHOD Across two studies, over 500 psychotherapy clients completed validated measures of alliance, social identification with their therapist, positive therapy outcomes, and a range of client and therapist characteristics. FINDINGS Social identification strongly predicted alliance in both samples, whereas client and therapist characteristics showed few such associations. Alliance mediated the relationship between social identification and positive therapy outcomes. In addition, we found evidence that (a) personal control is a key psychological resource in therapy that arises from social identification, and (b) therapists who engage in identity leadership (i.e., who represent and build a social identity that they share with clients) are more likely to foster social identification and its downstream benefits. INTERPRETATION These data show that social identity processes are key to the emergence of working alliance. We conclude with a discussion of how recent social identity and identity leadership interventions might be adapted to train therapists in relevant identity-building skills.
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Affiliation(s)
- Tegan Cruwys
- School of Medicine and Psychology, 39 Science Rd, The Australian National University, Canberra ACT 2601 Australia.
| | - Georgina C Lee
- School of Medicine and Psychology, 39 Science Rd, The Australian National University, Canberra ACT 2601 Australia
| | - Alysia M Robertson
- School of Medicine and Psychology, 39 Science Rd, The Australian National University, Canberra ACT 2601 Australia
| | - Catherine Haslam
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
| | - Nikola Sterling
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
| | - Michael J Platow
- School of Medicine and Psychology, 39 Science Rd, The Australian National University, Canberra ACT 2601 Australia
| | - Elyse Williams
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
| | - S Alexander Haslam
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
| | - Zoe C Walter
- School of Psychology, McElwain Building, The University of Queensland, St Lucia QLD 4067 Australia
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16
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Robinson A, De Boos D, Moghaddam N. Acceptance and commitment therapy (
ACT
) for people with dementia experiencing psychological distress: A hermeneutic single‐case efficacy design (
HSCED
) series. COUNSELLING & PSYCHOTHERAPY RESEARCH 2023. [DOI: 10.1002/capr.12646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Affiliation(s)
- Amie Robinson
- Division of Psychiatry and Applied Psychology University of Nottingham B Floor Yang Fujia, Jubilee Campus Nottingham UK
| | - Danielle De Boos
- Division of Psychiatry and Applied Psychology University of Nottingham B Floor Yang Fujia, Jubilee Campus Nottingham UK
| | - Nima Moghaddam
- College of Social Science University of Lincoln Brayford Pool Lincoln UK
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17
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Eslinger J, Sprang G, Jodts J. Keeping children and youth in trauma treatment: Examination of an alliance building dropout management program. Clin Child Psychol Psychiatry 2023; 28:721-733. [PMID: 35762135 DOI: 10.1177/13591045221111849] [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: 11/15/2022]
Abstract
Evidence-based treatments exist to address traumatic stress related symptoms for children, however dropout from trauma-focused treatment remains a concern. This study examined use of an alliance building dropout management program for a group of children ages 3-17 who received an evidence-based trauma-focused treatment. Logistic regression analysis was conducted to examine the relationships between child gender, race, ethnicity, age, guardianship, externalizing behaviors, participation in a dropout management program and the dose of treatment received. The final model was significant and participation in the dropout management program as well as a child's placement in foster care were significant individual correlates with full completion of treatment. Use of an Alliance Building Dropout Management program may help decrease overall dropout over and above the contribution of other variables known to impact treatment completion.
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Affiliation(s)
- Jessica Eslinger
- Department of Psychiatry, 12252University of Kentucky, Lexington, KY, USA.,Center on Trauma and Children, 4530University of Kentucky, Lexington, KY, USA
| | - Ginny Sprang
- Department of Psychiatry, 12252University of Kentucky, Lexington, KY, USA.,Center on Trauma and Children, 4530University of Kentucky, Lexington, KY, USA
| | - Jenna Jodts
- Center on Trauma and Children, 4530University of Kentucky, Lexington, KY, USA
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18
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Levitt HM, Grabowski LM, Minami T, Morrill Z. An initial validation of the Clients’ Experience of Therapy Scale (CETS): assessing the quality of psychotherapy process and outcome from clients’ perspectives. COUNSELLING PSYCHOLOGY QUARTERLY 2023. [DOI: 10.1080/09515070.2023.2191171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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19
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Clements-Hickman AL, Reese RJ. The person of the therapist: therapists' personal characteristics as predictors of alliance and treatment outcomes. Psychother Res 2023; 33:173-184. [PMID: 35634653 DOI: 10.1080/10503307.2022.2080610] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objective Studies examining the unique contribution that the therapist has on outcomes (i.e., "therapist effects") have increased in recent years. Therapist effects are believed to occur via how the therapist's interpersonal and intrapersonal qualities influence the therapeutic relationship, which in turn influences outcomes. The current study focused on the extent to which professional self-doubt, counseling self-efficacy, and humility are therapist qualities that influence treatment outcomes. Methods: Data were collected from 46 therapists at a multi-site community behavioral health organization. Therapists completed measures of therapist characteristics. Therapists' responses were matched with de-identified archival client data (N = 1, 817) that contained an outcome and alliance measure administered every session. Multilevel modeling was used to determine the extent to which therapists' personal characteristics predicted client outcomes. Results: Results of the unconditional model for the alliance measure indicated a lack of growth in alliance scores across treatment. Approximately 5% of the variance in rate of growth for treatment outcome was between therapists. When controlling for the effects of counseling self-efficacy, professional self-doubt was marginally significant. When counseling-self-efficacy was removed from the model, professional self-doubt was no longer marginally significant. Conclusion: The findings highlight the complexity of therapist effects and the need for future research on this topic.
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Affiliation(s)
| | - Robert J Reese
- Department of Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, AL, USA
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20
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Graham F, Williman J, Sutherland L, Wijninckx M. Telehealth delivery of paediatric rehabilitation for children with neurodisability: A mixed methods realist evaluation of contexts, mechanisms and outcomes. Child Care Health Dev 2023; 49:156-169. [PMID: 35778916 PMCID: PMC10084377 DOI: 10.1111/cch.13028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/31/2022] [Accepted: 06/21/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Teledelivery of rehabilitation services has been proposed as a cost-effective option for supporting children with neurodisability and their families. However, little is understood of the conditions that support uptake of telehealth in paediatric rehabilitation, what is delivered during telehealth or perceptions of its outcomes. The aim of this study was to identify the context, process and outcomes of telehealth for children with neurodisability and their families. A secondary objective was to identify if variations in these aspects of telehealth occurred for Māori, the indigenous people of New Zealand. METHOD A mixed-methods, three phase, realist evaluation identified context-mechanism-outcome configurations (CMOcs) of telehealth. In Phase 1, the Determinants of Implementation Behaviour Questionnaire indicated factors affecting practitioner uptake of telehealth (Context). In Phase 2, a casenote audit identified 'practitioner input' during telehealth (Mechanism). Phase 3 interviews with practitioners and parents explored 'parent response' to telehealth and practitioner and parent perceptions of its value (Mechanism and Outcomes). Subgroup analyses for Māori were planned. RESULTS From Phase 1, practitioners (29/37, 78%) intended to use telehealth; however, few did so regularly (7/37, 22%). Positive experiences of telehealth were described by all practitioners (n = 5) and families (n = 7) in Phase 3. CMOcs explained that practitioners' offering of telehealth occurred when practitioners were confident, valued access to therapy over the familiarity of in-person delivery, and when practitioners used coaching-style communication. Parents were receptive to telehealth when they trusted practitioners, felt listened to and were offered telehealth as a choice. When telehealth occurred, access to therapy was timely and more consistent than in-person delivery. Child outcomes appeared to be positive. Confidence in offering telehealth to Māori was low. CONCLUSIONS Initiatives to improve uptake of telehealth in paediatric rehabilitation should focus on creating conditions for practitioner implementation. Training in telehealth should include engagement with Māori. Adequate workspace and workplace culture change are required if telehealth is to be offered beyond the current 'early adopters'.
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Affiliation(s)
- Fiona Graham
- Department of Medicine: Rehabilitation Teaching and Research Unit, University of Otago, Christchurch, New Zealand
| | - Jonathan Williman
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Lena Sutherland
- Central Otago Health Care Service Limited, Otago, New Zealand
| | - Morgan Wijninckx
- South Island Alliance Programme Office (SIAPO), Christchurch, New Zealand
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21
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Ekbäck E, Rådmark L, Granåsen G, Svärling R, Sörlin M, Schönbeck C, Henje E. Clinical effectiveness of training for awareness, resilience, and action for adolescents and young adults with depression: The pilot phase of a multicenter randomized controlled trial. Front Psychiatry 2023; 14:1130035. [PMID: 37065894 PMCID: PMC10102586 DOI: 10.3389/fpsyt.2023.1130035] [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: 12/22/2022] [Accepted: 03/10/2023] [Indexed: 04/18/2023] Open
Abstract
Background Depression is a top-ranking global health concern increasing in magnitude. Available treatments for adolescents and young adults are not convincingly effective and relapse rates remain high. Training for Awareness, Resilience and Action (TARA) is a group treatment program targeting specific pathophysiological mechanisms of depression in young people. TARA is feasible, acceptable, preliminarily efficacious in depressed American adolescents, and it affects postulated brain-circuitry. Methods As an initial step of a multicenter randomized controlled trial (RCT) we performed a single-arm multicenter pilot-study on TARA. Thirty-five depressed individuals (15-21 years old, 28 females) received TARA for 12 weeks face-to-face or online. Data was collected before (T0), during, and after the intervention (T1). The trial was pre-registered at clinicaltrials.gov, NCT Registration: identifier [NCT04747340]. Feasibility outcomes included recruitment, attendance rates, and session ratings. Adverse events were recorded weekly and extracted from medical records at the end of the trial. Primary effectiveness outcome was self-rated depression severity on Reynolds Adolescent Depression scale 2nd ed. at T1. Secondary outcomes were Children's Depression Rating Scale-revised (CDRS-R) and Multidimensional Anxiety Scale for Children (MASC) at T1. Results TARA was feasible and safe in the present trial. No significant RADS-2-change was seen (adjusted mean difference -3.26, 95 % CI -8.35 to 1.83; p= 0.20), however a significant decrease in CDRS-R scores is reported (adjusted mean difference -9.99, 95% CI -14.76 to -5.22; p < 0.001). MASC-scores did not change significantly (adjusted mean difference 1.98, 95% CI -0.96 to 4.91; p=0.18). Additional feasibility aspects are presented and discussed. Discussion Limitations include substantial loss-to-follow-up, no randomization to control, and that some participants received concomitant treatment(s). The Coronavirus pandemic complicated both implementation and interpretation of the trial. In conclusion TARA was feasible and safe in depressed adolescents and young adults. Preliminary signs of effectiveness were seen. The initiated RCT will be important and worthwhile to conduct, and several improvements to the design are suggested based on the present results. Clinical Trial Registration clinicaltrials.gov, identifier NCT04747340.
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Affiliation(s)
- Erik Ekbäck
- Child and Adolescent Psychiatry, Department of Clinical Science, Umeå University, Umeå, Sweden
- *Correspondence: Erik Ekbäck,
| | - Lina Rådmark
- Child and Adolescent Psychiatry, Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Gabriel Granåsen
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Rachel Svärling
- Child and Adolescent Psychiatry, Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Matilda Sörlin
- Child and Adolescent Psychiatry, Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Caspar Schönbeck
- Child and Adolescent Psychiatry, Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Eva Henje
- Child and Adolescent Psychiatry, Department of Clinical Science, Umeå University, Umeå, Sweden
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22
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Taylor L, Giles S, Howitt S, Ryan Z, Brooks E, Radley L, Thomson A, Whitaker E, Knight F, Hill C, Violato M, Waite P, Raymont V, Yu LM, Harris V, Williams N, Creswell C. A randomised controlled trial to compare clinical and cost-effectiveness of an online parent-led treatment for child anxiety problems with usual care in the context of COVID-19 delivered in Child and Adolescent Mental Health Services in the UK (Co-CAT): a study protocol for a randomised controlled trial. Trials 2022; 23:942. [PMID: 36384704 PMCID: PMC9667839 DOI: 10.1186/s13063-022-06833-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the context of COVID-19, NHS Child and Adolescent Mental Health Services (CAMHS) and other children's mental health services have faced major challenges in providing psychological treatments that (i) work when delivered remotely and (ii) can be delivered efficiently to manage increases in referrals as social distancing measures have been relaxed. Anxiety problems are a common reason for referral to CAMHS, children with pre-existing anxiety problems are particularly vulnerable in the context of COVID-19, and there were concerns about increases in childhood anxiety as schools reopened. The proposed research will evaluate the clinical and cost-effectiveness of a brief online parent-led cognitive behavioural treatment (CBT) delivered by the OSI (Online Support and Intervention for child anxiety) platform with remote support from a CAMHS therapist compared to 'COVID-19 treatment as usual' (C-TAU) in CAMHS and other children's mental health services throughout the COVID-19 pandemic. METHODS We will conduct a two-arm, multi-site, randomised controlled non-inferiority trial to evaluate the clinical and cost-effectiveness of OSI with therapist support compared to CAMHS and other child mental health services 'COVID-19 treatment as usual' (C-TAU) during the COVID-19 outbreak and to explore parent and therapists' experiences. DISCUSSION If non-inferiority is shown, the research will provide (1) a solution for efficient psychological treatment for child anxiety disorders while social distancing (for the COVID-19 context and future pandemics); (2) an efficient means of treatment delivery as 'normal service' resumes to enable CAMHS to cope with the anticipated increase in referrals; and (3) a demonstration of rapid, high-quality evaluation and application of online interventions within NHS CAMHS to drive forward much-needed further digital innovation and evaluation in CAMHS settings. The primary beneficiaries will be children with anxiety disorders and their families, NHS CAMHS teams, and commissioners who will access a potentially effective, cost-effective, and efficient treatment for child anxiety problems. TRIAL REGISTRATION ISRCTN ISRCTN12890382 . Registered prospectively on 23 October 2020.
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Affiliation(s)
- Lucy Taylor
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Sophie Giles
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Sophie Howitt
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Zoe Ryan
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Emma Brooks
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Lucy Radley
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Abigail Thomson
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Emily Whitaker
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Fauzia Knight
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Claire Hill
- grid.9435.b0000 0004 0457 9566School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Mara Violato
- grid.4991.50000 0004 1936 8948Health Economics Research Centre, Nuffield Department of Population Health, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Polly Waite
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Vanessa Raymont
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- grid.4991.50000 0004 1936 8948Oxford Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Victoria Harris
- grid.4991.50000 0004 1936 8948Oxford Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Williams
- grid.4991.50000 0004 1936 8948Oxford Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Cathy Creswell
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
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23
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Kruger F, Terblanche NHD. Working Alliance Theory in Workplace Coaching: A Pilot Study Exploring the Missing Role of the Organization. JOURNAL OF APPLIED BEHAVIORAL SCIENCE 2022. [DOI: 10.1177/00218863221136125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Working alliance theory describes the therapist–client relationship in psychotherapy and has been adapted to study workplace coaching effectiveness. The application of this theory in workplace coaching research has produced mixed results suggesting that additional factors could be at play. In workplace coaching, the organization often pays for and influences the coaching process. The role of the organization in the working alliance between coach and coachee has, however, not been studied sufficiently. his exploratory, hybrid deductive–inductive qualitative study used the Working Alliance Inventory as theoretical lens to examine coachees’ perspectives on the organizational role in the coach–coachee working alliance. The findings indicate that organizations have a direct impact on the bond, task, and goals of the working alliance by facilitating the coaching process, influencing the coaching agenda and contract, and through coach selection. This tentative analysis suggests that measurements of the working alliance should be extended to include these organizational aspects.
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Affiliation(s)
- F. Kruger
- University of Stellenbosch Business School, Cape Town, South Africa
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Increasing the effectiveness of psychotherapy in routine care through blended therapy with transdiagnostic online modules (PsyTOM): study protocol for a randomized controlled trial. Trials 2022; 23:830. [PMID: 36180962 PMCID: PMC9524091 DOI: 10.1186/s13063-022-06757-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In blended therapy, face-to-face psychotherapy and Internet-based interventions are combined. Blended therapy may be advantageous for patients and psychotherapists. However, most blended interventions focus on cognitive behavioral therapy or single disorders, making them less suitable for routine care settings. METHODS In a randomized controlled trial, we will compare blended therapy and face-to-face therapy in routine care. We intend to randomize 1152 patients nested in 231 psychotherapists in a 1:1 ratio. Patients in the blended therapy group will receive access to a therapeutic online intervention (TONI). TONI contains 12 transdiagnostic online modules suited for psychodynamic, cognitive behavioral, and systemic therapy. Psychotherapists decide which modules to assign and how to integrate TONI components into the psychotherapeutic process to tailor treatment to their patients' specific needs. We will assess patients at baseline, 6 weeks, 12 weeks, and 6 months. Patients enrolled early in the trial will also complete assessments at 12 months. The primary outcomes are depression and anxiety at 6-month post-randomization, as measured by PHQ-8 and GAD-7. The secondary outcomes include satisfaction with life, level of functioning, personality traits and functioning, eating pathology, sexual problems, alcohol/drug use, satisfaction with treatment, negative effects, and mental health care utilization. In addition, we will collect several potential moderators and mediators, including therapeutic alliance, agency, and self-efficacy. Psychotherapists will also report on changes in symptom severity and therapeutic alliance. Qualitative interviews with psychotherapists and patients will shed light on the barriers and benefits of the blended intervention. Furthermore, we will assess significant others of enrolled patients in a sub-study. DISCUSSION The integration of online modules which use a common therapeutic language and address therapeutic principles shared across therapeutic approaches into regular psychotherapy has the potential to improve the effectiveness of psychotherapy and transfer it into everyday life as well help save therapists' resources and close treatment gaps. A modular and transdiagnostic setup of the blended intervention also enables psychotherapists to tailor their treatment optimally to the needs of their patients. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00028536. Registered on 07.06.2022.
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Validation of the French versions of two brief, clinician-friendly outcome monitoring tools: the ORS and SRS. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Moula Z, Powell J, Brocklehurst S, Karkou V. Feasibility, acceptability, and effectiveness of school-based dance movement psychotherapy for children with emotional and behavioral difficulties. Front Psychol 2022; 13:883334. [PMID: 36072049 PMCID: PMC9443698 DOI: 10.3389/fpsyg.2022.883334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSchools have been increasingly employing dance movement psychotherapists to support children cope with daily worries and stress, express and understand their emotions, develop self-awareness and self-esteem. However, evidence on the impact of dance movement psychotherapy as a tool for prevention of mental health difficulties in childhood remains limited.MethodsSixteen children (aged 7–9) with mild emotional and behavioral difficulties from two primary schools were randomly assigned to a Dance Movement Psychotherapy (DMP) intervention or to a waiting list, within a larger pilot cross-over randomized controlled study which aimed to (a) test whether all elements of study design can work together and run smoothly in a full-scale RCT; and (b) investigate the effectiveness of arts therapies in improving children’s health related quality of life (HRQOL; EQ-5D-Y), wellbeing and life functioning (Child Outcome Rating Scale; CORS), emotional and behavioral difficulties (Strengths and Difficulties Questionnaire; SDQ), and duration of sleep (Fitbits). The therapeutic process was also evaluated through interviews with children, participant observations, the Children’s Session Rating Scale (CSRS), and ratings of adherence to the therapeutic protocol.ResultsThe findings indicated that DMP led to improvements in children’s life functioning, wellbeing, duration of sleep, emotional and behavioral difficulties, but not in quality of life. The improvements were maintained at the follow-up stages, up to 6 months post-intervention. Interviews with children also suggested positive outcomes, such as self-expression; emotional regulation; mastery and acceptance of emotions; improved self-confidence and self-esteem; reduced stress; and development of positive relationships. However, children would have preferred smaller groups and longer sessions.ConclusionThis study indicated that all outcome measures would be suitable for inclusion in a larger randomized controlled trial, though the EQ-5D-Y is not recommended as a stand-alone measure due to its lack of sensitivity and specificity for young participants. The adherence to the therapeutic protocol ratings differed between children and adults, highlighting the need to include children’s voice in future research. Strategies are also proposed of how to conduct randomization of participants in ways that do not hinder the therapeutic process.
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Affiliation(s)
- Zoe Moula
- Imperial College London, London, United Kingdom
- *Correspondence: Zoe Moula,
| | - Joanne Powell
- Faculty of Health, Social Care & Medicine and Faculty of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Shirley Brocklehurst
- Faculty of Health, Social Care & Medicine and Faculty of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Vicky Karkou
- Faculty of Health, Social Care & Medicine and Faculty of Psychology, Edge Hill University, Ormskirk, United Kingdom
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Dorais S, Niles J, Dukes AT, Colon ML, Gutierrez D. Does contemplative pedagogy increase relational well‐being? A time series analysis. COUNSELOR EDUCATION AND SUPERVISION 2022. [DOI: 10.1002/ceas.12244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Stephanie Dorais
- Department of School Psychology and Counselor Education William & Mary Williamsburg Virginia USA
| | - Jennifer Niles
- Department of School Psychology and Counselor Education William & Mary Williamsburg Virginia USA
| | - Allison T. Dukes
- Department of School Psychology and Counselor Education William & Mary Williamsburg Virginia USA
| | - Michelle L. Colon
- School of Counseling and Special Education Bowling Green State University Bowling Green Ohio USA
| | - Daniel Gutierrez
- Department of Counseling and Special Education Virginia Commonwealth University Richmond Virginia USA
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Hauber K, Boon A. First-Session Therapeutic Relationship and Outcome in High Risk Adolescents Intensive Group Psychotherapeutic Programme. Front Psychol 2022; 13:916888. [PMID: 35783793 PMCID: PMC9245890 DOI: 10.3389/fpsyg.2022.916888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAn important determinant of therapy outcome is the quality of the therapeutic relationship. This study evaluated the association between the client’s assessment of first-session therapeutic relationship (FSTR) and outcome in an intensive treatment for adolescents with personality disorders.MethodPatients (N = 92) were measured weekly during intensive group treatment. The therapeutic relationship was measured with the Child version of the Session Rating Scale (C-SRS) that was completed after each group therapy session by the patient. Outcome was measured with the Child version of the Outcome Rating Scale (C-ORS). Reliable change index (RCI) was calculated for the both instruments to determine significant changes in therapeutic relationship and outcome.ResultsA good FRST gave twice as much chance of a significantly better outcome. Especially for those with moderate FSTR, establishing and maintaining a good working relationship during treatment could increase the chances of a good outcome considerably. In contrast, adolescents with low FSTR had little chance of positive outcome regardless of any improvement in the therapeutic relationship.ConclusionAdolescents assessment of FRST is indicative of the chance of a good outcome.
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Affiliation(s)
- Kirsten Hauber
- LUMC Curium, Child and Adolescent Psychiatry, Leiden University Medical Centre, Leiden, Netherlands
- Parnassia Psychiatric Institute, Youz Child and Adolescent Psychiatry, The Hague, Netherlands
- *Correspondence: Kirsten Hauber,
| | - Albert Boon
- LUMC Curium, Child and Adolescent Psychiatry, Leiden University Medical Centre, Leiden, Netherlands
- Parnassia Psychiatric Institute, Youz Child and Adolescent Psychiatry, The Hague, Netherlands
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Mulligan A, Sresthaporn N, Mulroy S, Rudd T, Coffey A, Joyce M, Gadancheva V, Glancy C. Development, preliminary validation and reliability of the colourful 'My Feelings Form' self-report for young children. Child Adolesc Ment Health 2022; 28:299-306. [PMID: 35614029 DOI: 10.1111/camh.12566] [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] [Accepted: 04/05/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patient-reported outcome measures place the patient at the centre of his/her care. There are calls to introduce child-reported outcome measures to mental health services. We aimed to (a) develop an age-appropriate patient-reported outcome measure for children's mental health, and (b) validate this in a primary school and Child and Adolescent Mental Health Service (CAMHS). METHODS A list of items to measure children's mental health was proposed (Draft 1) and revised to 14 items following focus group and user consultation (Draft 2). A colourful, cartoon and emoji version was created in consultation with children (Draft 3); a professional cartoon artist created the final 'My Feelings Form' (MFF), with usability feedback (Draft 4). The MFF was tested by 317 children aged 4-13 years from one mixed-gender primary school at two time points in 1 day, and 25 children aged 4-13 years from CAMHS. Results were analysed using test-retest reliability and exploratory factor analysis; a receiver operator characteristic curve was constructed. RESULTS The CAMHS group scored significantly higher than the school group for the mean total score (23.5 ± 11.3 vs. 16.1 ± 6.2) and for 10 items. Test-retest reliability was acceptable (correlation = 0.74, p < .001). Exploratory factor analysis using 10 informative items identified two factors - emotional factor (Cronbach's alpha = 0.74) and function factor (Cronbach's alpha = 0.59). The revised 10-item form has a Cronbach's alpha of 0.77; a cut-off of 12 has a sensitivity of 80% and specificity of 60%, indicating that it correctly identified 80% of those who were attending CAMHS and gave 60% of the schoolchildren a negative result. CONCLUSIONS The colourful MFF was co-produced with children, and preliminary data suggest that it is a useful patient-reported outcome measure for children's mental health.
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Affiliation(s)
- Aisling Mulligan
- Department of Child and Adolescent Psychiatry, School of Medicine, University College Dublin, Dublin, Ireland.,Dublin North City and County Child and Adolescent Mental Health Service, Dublin, Ireland
| | | | - Sinead Mulroy
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Tara Rudd
- Dublin North City and County Child and Adolescent Mental Health Service, Dublin, Ireland
| | - Anne Coffey
- Department of Psychotherapy, University College Dublin, Dublin, Ireland
| | - Maria Joyce
- Department of Psychotherapy, University College Dublin, Dublin, Ireland
| | - Veselina Gadancheva
- Dublin North City and County Child and Adolescent Mental Health Service, Dublin, Ireland
| | - Caoimhe Glancy
- School of Medicine, University College Dublin, Dublin, Ireland
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Tymofiyeva O, Hu MY, Sipes BS, Jakary A, Glidden DV, Jariwala N, Bhandari S, Parks KC, Nguyen C, Henje E, Yang TT. A Feasibility Study of a Remotely-Delivered Mindfulness-Based Training for Adolescents During the COVID-19 Pandemic. Front Psychiatry 2022; 13:838694. [PMID: 35633797 PMCID: PMC9133427 DOI: 10.3389/fpsyt.2022.838694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
Social distancing, home confinement, economic challenges, and COVID-19-related illness and deaths during the COVID-19 pandemic can significantly affect mental health in youth. One promising approach to reduce anxiety and depression in adolescents is the neuroscience-based mindfulness intervention Training for Awareness, Resilience, and Action (TARA). The objective of this individually randomized waitlist-controlled trial (RCT) was (1) to test the feasibility of TARA, delivered partially over Zoom, and (2) to assess changes in the emotional wellbeing in healthy adolescents between the ages of 14-18 years old during the COVID-19 pandemic. METHODS Twenty-one healthy adolescents were randomized to the TARA intervention or to the waitlist control group in February 2020, just before the start of the pandemic. The TARA group intervention was delivered in person for the first five sessions and remotely over Zoom for the remaining seven sessions due to the pandemic. The participants' acceptability of TARA was assessed weekly using the Child Session Rating Scale (CSRS). The primary outcome was the emotional wellbeing measured using emotional symptoms subscale of the Strengths and Difficulties Questionnaire (SDQ) pre/post-TARA. We also explored weekly changes in TARA participants' wellbeing using the Child Outcome Rating Scale (CORS). RESULTS The overall session rating in TARA participants improved after the switch to Zoom (Cohen's d = 1.2, p = 0.008). The results of the two-way ANOVA showed no statistically significant difference in the change of the SDQ emotional symptoms during the 12 weeks between the TARA group and waitlist-control group (timepoint × group interaction: F = 0.77, p = 0.38). The exploratory analysis using the CORS in the TARA participants showed a significant improvement in their functioning over the weeks of training. CONCLUSION Our results support the feasibility of TARA delivered over Zoom. While our primary outcome did not provide support for the improvement of the emotional wellbeing with TARA compared to a passive control group, our exploratory analysis in the intervention group indicated an improved functioning over the weeks of TARA training. The important general positive impact of this study lies in the possibility of offering a neuroscience-based mindfulness intervention remotely to youth living in remote areas and for all youth during pandemic times.
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Affiliation(s)
- Olga Tymofiyeva
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Melody Y. Hu
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Langley Porter Psychiatric Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Benjamin S. Sipes
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Angela Jakary
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Namasvi Jariwala
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Sarina Bhandari
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Kendall C. Parks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Ca Nguyen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Eva Henje
- Department of Clinical Science, Child and Adolescent Psychiatry, Umeå University, Umeå, Sweden
| | - Tony T. Yang
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Langley Porter Psychiatric Institute, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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Online Support and Intervention (OSI) for child anxiety: a case series within routine clinical practice. Behav Cogn Psychother 2022; 50:429-445. [PMID: 35506631 DOI: 10.1017/s1352465822000157] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Online treatments for child anxiety offer a potentially cost-effective and non-stigmatizing means to widen access to evidence-based treatments and meet the increasing demand on services; however, uptake in routine clinical practice remains a challenge. This study conducted an initial evaluation of the clinical effectiveness, feasibility and acceptability of OSI (Online Support and Intervention for child anxiety) within clinical practice. OSI is a co-designed online therapist-supported, parent-led CBT treatment for pre-adolescent children with anxiety problems. METHOD This case series was part of routine service evaluation in a clinic in England where families were offered OSI to treat a primary anxiety difficulty among 7- to 12-year-old children; 24 families were offered OSI, and 23 took it up. Measures of anxiety symptomatology, functional impairment and progress towards therapeutic goals were taken at pre-treatment, post-treatment and 4-week follow-up. Treatment satisfaction and engagement were also measured throughout the intervention. RESULTS Mean anxiety symptoms significantly improved to below the clinical cut-off post-treatment, with further reduction at follow-up. Functional impairment also significantly improved and significant progress was made towards treatment goals. The majority of children showed reliable change in anxiety symptoms and reliable recovery by follow-up, and were discharged without needing further treatment for anxiety. Uptake, adherence and engagement in OSI were excellent, and parents reported high levels of satisfaction with the treatment. CONCLUSIONS We have provided initial evidence that OSI is feasible, acceptable to families, and appears to be associated with good outcomes within routine clinical practice.
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Waite P. Protocol for a randomised controlled feasibility study examining the efficacy of brief cognitive therapy for the treatment of panic disorder in adolescents (PANDA). Pilot Feasibility Stud 2022; 8:49. [PMID: 35241182 PMCID: PMC8891743 DOI: 10.1186/s40814-022-01009-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Panic disorder occurs in between 1 and 3% of adolescents, is associated with high levels of co-morbidity, and without treatment, appears to have a chronic course. To improve access to effective psychological interventions, briefer versions of cognitive behaviour therapy (CBT) have been developed and evaluated for preadolescent children with anxiety disorders. However, there are currently no brief evidence-based CBT interventions for adolescents with anxiety disorders that can be delivered in less than eight sessions. Given that a brief version of cognitive therapy has been shown to be effective in adults with panic disorder, it is possible that an adapted version could be effective for adolescents with panic disorder. METHODS The study will examine whether a definitive trial can be conducted, based on a single-centre feasibility randomised controlled trial using several well-defined criteria. Between 30 and 48 young people (age 11-18 years) who meet diagnostic criteria for panic disorder, attending a routine clinical service will be randomly allocated to receive either (i) brief cognitive therapy or (ii) a general form of CBT treatment that is more commonly used for adolescents with anxiety disorders. Both will be delivered 1:1 by a therapist and involve five treatment sessions and two booster sessions. Young people's outcomes will be assessed at the end of treatment and at 3-month follow-up, and qualitative interviews will be conducted to examine acceptability. We will also explore outcomes 1 year after the completion of treatment. DISCUSSION This study will test the feasibility of a randomised controlled trial to compare brief cognitive therapy to a general form of CBT for adolescents with panic disorder in the UK. The outputs from the study will provide a clear indication of the feasibility of a future definitive trial and, if indicated, the critical resources that will be required and key information to inform the design and maximise the successful completion of the trial. This has the potential to bring direct benefits to young people and their families, as well as services and society more broadly. TRIAL REGISTRATION This trial is registered on the ISRCTN Registry, registration number ISRCTN14884288 , registered retrospectively on 05/12/2019.
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Affiliation(s)
- Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK. .,Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, OX2 6GG, UK.
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Ekbäck E, von Knorring J, Burström A, Hunhammar D, Dennhag I, Molin J, Henje E. Training for Awareness, Resilience and Action (TARA) for medical students: a single-arm mixed methods feasibility study to evaluate TARA as an indicated intervention to prevent mental disorders and stress-related symptoms. BMC MEDICAL EDUCATION 2022; 22:132. [PMID: 35227281 PMCID: PMC8883651 DOI: 10.1186/s12909-022-03122-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/13/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND Medical students have a higher risk for depression, anxiety, stress-related symptoms, burnout, and suicide, and more rarely seek professional help or treatment than the general population. Appeals are being made to address the mental health and resilience of physicians-to-be. The novel program Training for Awareness, Resilience, and Action (TARA) was originally developed to treat depressed adolescents, targeting specific neuroscientific findings in this population. TARA has shown feasibility and preliminary efficacy in clinically depressed adolescents and corresponding brain-changes in mixed community adolescent samples. The present study investigated the feasibility and acceptability of TARA as a potential indicated prevention program for symptoms of depression, anxiety, stress and burnout in Swedish medical students. METHODS We conducted a single-arm trial with 23 self-selected students in their early semesters of medical school (mean age 25.38 years, 5 males and 18 females), with or without mental disorders. All participants received TARA. Self-reported symptoms of depression, anxiety, perceived stress and psychological inflexibility were collected before (T0) and after the intervention (T1). Qualitative data on the participants' experiences of TARA were collected in focus-group interviews conducted halfway through the program and upon completion of the program. Individual interviews were also conducted 2 years later. Qualitative content analysis was performed. RESULTS The mean attendance rate was 61.22% and the dropout rate was 17.40%. The Child Session Rating Scale administered after every session reflected an overall acceptable content, mean total score 34.99 out of 40.00. Trends towards improvement were seen across all outcome measures, including the Hospital Anxiety and Depression Scale Anxiety (t = 1.13, p = 0.29) and Depression (t = 1.71, p = 0.11) subscales, Perceived Stress Scale (t = 0.67, p = 0.51) and Avoidance and Fusion Questionnaire for youth (t = 1.64, p = 0.10). None of the participants deteriorated markedly during the intervention. Qualitative content analysis resulted in a main theme labeled: "An uncommon meeting-ground for personal empowerment", with 4 themes; "Acknowledging unmet needs", "Entering a free zone", "Feeling connected to oneself and others" and "Expanding self-efficacy". CONCLUSION TARA is feasible and acceptable in a mixed sample of Swedish medical students. The students' reports of entering an uncommon meeting-ground for personal empowerment supports effectiveness studies of TARA in this context.
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Affiliation(s)
- Erik Ekbäck
- Department of Clinical Science, Umeå University, Umeå, Sweden.
| | | | - Anna Burström
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - David Hunhammar
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Inga Dennhag
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Jenny Molin
- Department of Nursing, Department of Clinical Science, Umeå university, Umeå, Sweden
| | - Eva Henje
- Department of Clinical Science, Umeå University, Umeå, Sweden
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Larsson I, Aili K, Nygren JM, Johansson P, Jarbin H, Svedberg P. SLEEP: intervention with weighted blankets for children with attention deficit hyperactivity disorder (ADHD) and sleep problems: study protocol for a randomised control trial. BMJ Open 2022; 12:e047509. [PMID: 34983749 PMCID: PMC8728406 DOI: 10.1136/bmjopen-2020-047509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of sleep problems. Weighted blankets are one possible non-pharmacological intervention for these problems in this group of children. However, the effectiveness of weighted blankets is insufficiently investigated. This study aims to investigate the effectiveness of weighted blankets in terms of sleep, health-related outcomes and cost-effectiveness as well as to explore children's and parents' experiences of a sleep intervention with weighted blankets. METHODS AND ANALYSIS This study is a randomised placebo-controlled crossover trial comparing the effect of weighted fibre blankets (active) with fibre blankets without weight (control). Children aged 6-13 years, recently diagnosed with uncomplicated ADHD with verified sleep problems, were included in the study. The study period is 4 weeks for each condition, respectively, and then an 8-week follow-up. A total of 100 children diagnosed with ADHD and sleep problems will enter the study. The primary outcomes are sleep and cost per quality-adjusted life years. The secondary outcomes are health-related quality of life, ADHD symptoms, psychological distress and anxiety. Interviews with a subsample of the participating children and parents will be conducted for exploring the experiences of the intervention. ETHICS AND DISSEMINATION Ethical approval of the trial has been obtained from the Swedish Ethical Review Authority (number 2019--2158) and conforms to the principles outlined in the Declaration of Helsinki (WMA, 2013). Results will be reported as presentations at peer-review conferences, in articles in peer-review journals and meetings with healthcare providers. TRIAL REGISTRATION NUMBER NCT04180189.
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Affiliation(s)
- Ingrid Larsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Katarina Aili
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Pia Johansson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Håkan Jarbin
- Faculty of Medicine, Lund University, Lund, Sweden
- Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Krause KR, Edbrooke-Childs J, Singleton R, Wolpert M. Are We Comparing Apples with Oranges? Assessing Improvement Across Symptoms, Functioning, and Goal Progress for Adolescent Anxiety and Depression. Child Psychiatry Hum Dev 2022; 53:737-753. [PMID: 33826029 PMCID: PMC9287244 DOI: 10.1007/s10578-021-01149-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 12/16/2022]
Abstract
Strategies for comparing routinely collected outcome data across services or systems include focusing on a common indicator (e.g., symptom change) or aggregating results from different measures or outcomes into a comparable core metric. The implications of either approach for judging treatment success are not fully understood. This study drew on naturalistic outcome data from 1641 adolescents with moderate or severe anxiety and/or depression symptoms who received routine specialist care across 60 mental health services in England. The study compared rates of meaningful improvement between the domains of internalizing symptoms, functioning, and progress towards self-defined goals. Consistent cross-domain improvement was observed in only 15.6% of cases. Close to one in four (24.0%) young people with reliably improved symptoms reported no reliable improvement in functioning. Inversely, one in three (34.8%) young people reported meaningful goal progress but no reliable symptom improvement. Monitoring systems that focus exclusively on symptom change risk over- or under-estimating actual impact, while aggregating different outcomes into a single metric can mask informative differences in the number and type of outcomes showing improvement. A move towards harmonized outcome measurement approaches across multiple domains is needed to ensure fair and meaningful comparisons.
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Affiliation(s)
- Karolin Rose Krause
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK.
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK.
| | - Julian Edbrooke-Childs
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
| | - Rosie Singleton
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
| | - Miranda Wolpert
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE, UK
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Conducting practice‐based research with a counsellor in private practice. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Buijs PC, Bassett AS, Gold DA, Boot E. Cognitive behavioral therapy in 22q11.2 deletion syndrome: A case study of two young adults with an anxiety disorder. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:695-704. [PMID: 32772800 DOI: 10.1177/1744629520942374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The prevalence of anxiety disorders is high in 22q11.2 deletion syndrome (22q11.2DS), an under-recognized multisystem condition. Prominent features include an array of somatic, cognitive, and neuropsychiatric disorders. This case study reports for the first time on the application of individual cognitive behavioral therapy in 22q11.2DS. METHOD Two young adults with 22q11.2DS and an anxiety disorder received cognitive behavioral therapy based on standard protocols. Feasibility and efficacy were assessed through clinical interviews, clinical observations by the therapist, and questionnaires. RESULTS Both participants were engaged in the therapy and showed understanding of basic cognitive behavioral therapy principles. However, they did not show a clear clinical improvement. Adjustments to the protocol were required, including increased flexibility and a proactive approach by the therapist, additional time per session, written information, and significant involvement of the family and multidisciplinary team. CONCLUSIONS Our findings may help identify required adaptations to cognitive behavioral therapy protocols for this and similar genetic conditions.
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Affiliation(s)
- Petra Cm Buijs
- The Dalglish Family 22q Clinic, University Health Network, Canada
- Kenter Jeugdhulp, Child and Adolescent Mental Health Care, The Netherlands
| | - Anne S Bassett
- The Dalglish Family 22q Clinic, University Health Network, Canada
- Clinical Genetics Research Program, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada
- Department of Psychiatry, Division of Cardiology, Department of Medicine, and Toronto General Research Institute, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
| | - David A Gold
- Department of Psychiatry, University of Toronto, Canada
- Neuropsychology Clinic, Krembil Neuroscience Centre, University Health Network, Canada
| | - Erik Boot
- The Dalglish Family 22q Clinic, University Health Network, Canada
- Advisium,'s Heeren Loo Zorggroep, Amersfoort, The Netherlands
- Department of Psychiatry & Neuropsychology, Maastricht University, The Netherlands
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Johansson M, Berman AH, Sinadinovic K, Lindner P, Hermansson U, Andréasson S. Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance: Three-Armed Randomized Trial. J Med Internet Res 2021; 23:e29666. [PMID: 34821563 PMCID: PMC8663526 DOI: 10.2196/29666] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Alcohol use is a major contributor to health loss. Many persons with harmful use or alcohol dependence do not obtain treatment because of limited availability or stigma. They may use internet-based interventions as an alternative way of obtaining support. Internet-based interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use; however, few studies have been conducted with a specific focus on harmful use or alcohol dependence. The importance of therapist guidance in internet-based cognitive behavioral therapy (ICBT) programs is still unclear. Objective This trial aims to investigate the effects of a web-based alcohol program with or without therapist guidance among anonymous adult help-seekers. Methods A three-armed randomized controlled trial was conducted to compare therapist-guided ICBT and self-help ICBT with an information-only control condition. Swedish-speaking adult internet users with alcohol dependence (3 or more International Classification of Diseases, Tenth Revision criteria) or harmful alcohol use (alcohol use disorder identification test>15) were included in the study. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of 5 main modules, as well as a drinking calendar with automatic feedback. Guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol-related problems measured using the total alcohol use disorder identification test-score, diagnostic criteria for alcohol dependence and alcohol use disorder, depression, anxiety, health, readiness to change, and access to other treatments or support. Follow-up was conducted 3 (posttreatment) and 6 months after recruitment. Results During the recruitment period, from March 2015 to March 2017, 1169 participants were included. Participants had a mean age of 45 (SD 13) years, and 56.72% (663/1169) were women. At the 3-month follow-up, the therapist-guided ICBT and control groups differed significantly in weekly alcohol consumption (−3.84, 95% Cl −6.53 to −1.16; t417=2.81; P=.005; Cohen d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between the self-help ICBT and the control group at 3 months, or between any of the groups at the 6-month follow-up. A limitation of the study was the large number of participants who were completely lost to follow-up (477/1169, 40.8%). Conclusions In this study, a therapist-guided ICBT program was not found to be more effective than the same program in a self-help ICBT version for reducing alcohol consumption or other alcohol-related outcomes. In the short run, therapist-guided ICBT was more effective than information. Only some internet help-seekers may need a multisession program and therapist guidance to change their drinking when they use internet-based interventions. Trial Registration ClinicalTrials.gov NCT02377726; https://clinicaltrials.gov/ct2/show/NCT02377726
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Affiliation(s)
- Magnus Johansson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Anne H Berman
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Kristina Sinadinovic
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Philip Lindner
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Ulric Hermansson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Sven Andréasson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Quirk K, Drinane JM, Edelman A, Chow D, Lim J, Chandra D, Miller S, Owen J. The Alliance-Outcome Association in Couple Therapy: A Common Fate Model. FAMILY PROCESS 2021; 60:741-754. [PMID: 34037992 DOI: 10.1111/famp.12666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The working alliance has been shown to be a robust predictor of couple therapy outcomes. However, there are still questions regarding the best way to conceptualize and analyze the association between the alliance and outcomes in the couple therapy context. This study presents results from a relatively novel analytic approach for evaluating the alliance and therapy outcomes via the shared influence model (i.e., common fate statistical methodology) with 93 couples who had at least three sessions. Examining the alliance in couple therapy this way allows for nuance in conceptualizing the process of the alliance among partners and the therapist in couple therapy. Empirically, the question that remains is whether the shared experience of the alliance between partners is a stronger predictor of therapy outcome as compared to the unique individual experiences of the alliance. This approach has not yet been utilized to model the couple alliance-outcome association. Results revealed that the shared influence model demonstrated a significant association between the alliance and therapy outcome. Specifically, the couple-level alliance construct was adequately represented from the partners' alliance ratings with the therapist, and couples that report higher shared alliance experiences were also likely to have better therapy outcomes. These findings suggest that conceptualizing and analyzing the alliance at the couple level may be strongly advantageous. Implications for research and practice are provided.
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Affiliation(s)
- Kelley Quirk
- Colorado State University, Fort Collins, CO, USA
| | | | | | - Daryl Chow
- International Center for Clinical Excellence, Institute of Mental Health, Singapore, Singapore
| | - Joline Lim
- Eagles Mediation and Counselling Center, Singapore, Singapore
| | - Diana Chandra
- Eagles Mediation and Counselling Center, Singapore, Singapore
| | - Scott Miller
- International Center for Clinical Excellence, Chicago, IL, USA
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Peterson BS, West AE, Weisz JR, Mack WJ, Kipke MD, Findling RL, Mittman BS, Bansal R, Piantadosi S, Takata G, Koebnick C, Ashen C, Snowdy C, Poulsen M, Arora BK, Allem CM, Perez M, Marcy SN, Hudson BO, Chan SH, Weersing R. A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders. BMC Psychiatry 2021; 21:323. [PMID: 34193105 PMCID: PMC8243307 DOI: 10.1186/s12888-021-03314-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/04/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Treatment of a child who has an anxiety disorder usually begins with the question of which treatment to start first, medication or psychotherapy. Both have strong empirical support, but few studies have compared their effectiveness head-to-head, and none has investigated what to do if the treatment tried first isn't working well-whether to optimize the treatment already begun or to add the other treatment. METHODS This is a single-blind Sequential Multiple Assignment Randomized Trial (SMART) of 24 weeks duration with two levels of randomization, one in each of two 12-week stages. In Stage 1, children will be randomized to fluoxetine or Coping Cat Cognitive Behavioral Therapy (CBT). In Stage 2, remitters will continue maintenance-level therapy with the single-modality treatment received in Stage 1. Non-remitters during the first 12 weeks of treatment will be randomized to either [1] optimization of their Stage 1 treatment, or [2] optimization of Stage 1 treatment and addition of the other intervention. After the 24-week trial, we will follow participants during open, naturalistic treatment to assess the durability of study treatment effects. Patients, 8-17 years of age who are diagnosed with an anxiety disorder, will be recruited and treated within 9 large clinical sites throughout greater Los Angeles. They will be predominantly underserved, ethnic minorities. The primary outcome measure will be the self-report score on the 41-item youth SCARED (Screen for Child Anxiety Related Disorders). An intent-to-treat analysis will compare youth randomized to fluoxetine first versus those randomized to CBT first ("Main Effect 1"). Then, among Stage 1 non-remitters, we will compare non-remitters randomized to optimization of their Stage 1 monotherapy versus non-remitters randomized to combination treatment ("Main Effect 2"). The interaction of these main effects will assess whether one of the 4 treatment sequences (CBT➔CBT; CBT➔med; med➔med; med➔CBT) in non-remitters is significantly better or worse than predicted from main effects alone. DISCUSSION Findings from this SMART study will identify treatment sequences that optimize outcomes in ethnically diverse pediatric patients from underserved low- and middle-income households who have anxiety disorders. TRIAL REGISTRATION This protocol, version 1.0, was registered in ClinicalTrials.gov on February 17, 2021 with Identifier: NCT04760275 .
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Affiliation(s)
- Bradley S. Peterson
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Psychiatry, Keck School of Medicine at The University of Southern California, Los Angeles, USA
| | - Amy E. West
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - John R. Weisz
- grid.38142.3c000000041936754XDepartment of Psychology, Harvard University, Cambridge, USA
| | - Wendy J. Mack
- grid.42505.360000 0001 2156 6853Department of Preventive Medicine, Keck School of Medicine at The University of Southern California, Los Angeles, USA
| | - Michele D. Kipke
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA ,grid.42505.360000 0001 2156 6853Department of Preventive Medicine, Keck School of Medicine at The University of Southern California, Los Angeles, USA
| | - Robert L. Findling
- grid.224260.00000 0004 0458 8737Virginia Commonwealth University, Richmond, USA
| | - Brian S. Mittman
- grid.414895.50000 0004 0445 1191Department of Research & Evaluation, Kaiser Permanente, Los Angeles, USA
| | - Ravi Bansal
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Steven Piantadosi
- grid.38142.3c000000041936754XBrigham And Women’s Hospital, Harvard Medical School, Boston, USA
| | - Glenn Takata
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Corinna Koebnick
- grid.414895.50000 0004 0445 1191Department of Research & Evaluation, Kaiser Permanente, Los Angeles, USA
| | - Ceth Ashen
- Children’s Bureau of Southern California, Los Angeles, USA
| | - Christopher Snowdy
- grid.42505.360000 0001 2156 6853Department of Psychiatry, Keck School of Medicine at The University of Southern California, Los Angeles, USA
| | - Marie Poulsen
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Bhavana Kumar Arora
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Courtney M. Allem
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Marisa Perez
- Hathaway-Sycamores Child and Family Services, Altadena, USA
| | - Stephanie N. Marcy
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Bradley O. Hudson
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | | | - Robin Weersing
- grid.263081.e0000 0001 0790 1491SDSU-UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, USA
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Johansson M, Sinadinovic K, Gajecki M, Lindner P, Berman AH, Hermansson U, Andréasson S. Internet-based therapy versus face-to-face therapy for alcohol use disorder, a randomized controlled non-inferiority trial. Addiction 2021; 116:1088-1100. [PMID: 32969541 PMCID: PMC8247312 DOI: 10.1111/add.15270] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/08/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Most people with alcohol use disorder (AUD) are never treated. Internet-based interventions are effective in reducing alcohol consumption and could help to overcome some of the barriers to people not seeking or receiving treatment. The aim of the current study was to compare internet-delivered and face-to-face treatment among adult users with AUD. DESIGN Randomized controlled non-inferiority trial with a parallel design, comparing internet-delivered cognitive-behavioural therapy (ICBT) (n = 150) with face-to-face CBT (n = 151), at 3- and 6-month follow-ups. SETTING A specialized clinic for people with AUD in Stockholm, Sweden. Participants were recruited between 8 December 2015 and 5 January 2018. PARTICIPANTS A total of 301 patients [mean age 50 years, standard deviation (SD) = 12.3] with AUD, of whom 115 (38%) were female and 186 (62%) were male. INTERVENTION AND COMPARATOR Participants were randomized in blocks of 20 at a ratio of 1 : 1 to five modules of therapist-guided ICBT or to five modules of face-to-face CBT, delivered over a 3-month period. The same treatment material and the same therapists were used in both groups. MEASUREMENTS The primary outcome was standard drinks of alcohol consumed during the previous week at 6-month follow-up, analysed according to intention-to-treat. The pre-specified non-inferiority limit was five standard drinks of alcohol and d = 0.32 for secondary outcomes. RESULTS The difference in alcohol consumption between the internet and the face-to-face group was non-inferior in the intention-to-treat analysis of data from the 6-month follow-up [internet = 12.33 and face-to-face = 11.43, difference = 0.89, 95% confidence interval (CI) = -1.10 to 2.88]. The secondary outcome, Alcohol Use Disorder Identification Test score, failed to show non-inferiority of internet compared with face-to-face in the intention-to-treat analysis at 6-month follow-up (internet = 12.26 and face-to-face = 11.57, d = 0.11, 95% CI = -0.11 to 0.34). CONCLUSIONS Internet-delivered treatment was non-inferior to face-to-face treatment in reducing alcohol consumption among help-seeking patients with alcohol use disorder but failed to show non-inferiority on some secondary outcomes.
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Affiliation(s)
- Magnus Johansson
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Kristina Sinadinovic
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Mikael Gajecki
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Anne H. Berman
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
- Department of PsychologyUppsala UniversityUppsalaSweden
| | - Ulric Hermansson
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Sven Andréasson
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
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She Z, Shi Y, Duncan BL, Xie D, Xi J, Sun Q, Ji W. Psychometric properties and longitudinal invariance of the session rating scale in Chinese clinical samples. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01721-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Meis LA, Noorbaloochi S, Hagel Campbell EM, Erickson EPG, Velasquez TL, Leverty DM, Thompson K, Erbes C. A Theory of Planned Behavior Scale for Adherence to Trauma-Focused Posttraumatic Stress Disorder Treatments. J Trauma Stress 2021; 34:440-453. [PMID: 33200475 DOI: 10.1002/jts.22620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/25/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022]
Abstract
Evidence-based psychotherapies for posttraumatic stress disorder (PTSD), such as cognitive processing therapy and prolonged exposure (CPT/PE), greatly reduce suffering for veterans, but many veterans fail to complete treatment. Developing a theory-based understanding of adherence is necessary to inform interventions to improve treatment retention. We developed and tested a series of scales applying the theory of planned behavior (TPB) to CPT/PE adherence. The scales were administered in mailed surveys as part of a larger mixed-methods study of veteran adherence to PE/CPT. Surveys were sent to 379 veterans who were initiating CPT/PE across four U.S. Veterans Affairs (VA) hospitals and 207 of their loved ones. Subsequent session attendance and homework compliance were coded via a review of electronic medical records. We examined item-level characteristics, factor structure, and the convergent and discriminant validity of the resultant scales. The findings support four subscales: two related to attitudes (i.e., Treatment Makes Sense and Treatment Fits Needs), one related to perceived behavioral control over participation (i.e., Participation Control), and one related to perceived family attitudes about CPT/PE participation (i.e., Subjective Norms). Scale validity was supported through significant associations with theoretically relevant constructs, including intentions to persist in CPT/PE, rs = .19-.38; treatment completion, rs = .21-.25; practical treatment barriers, rs = -.19 to -.24; and therapeutic alliance, rs = .39-.57.
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Affiliation(s)
- Laura A Meis
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Siamak Noorbaloochi
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Emily M Hagel Campbell
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Emily P G Erickson
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Tina L Velasquez
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - David M Leverty
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Katie Thompson
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Christopher Erbes
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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van Leer E. Enhancing Adherence to Voice Therapy via Social Cognitive Strategies. Semin Speech Lang 2021; 42:19-31. [PMID: 33596601 DOI: 10.1055/s-0040-1722755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Treatment adherence is a challenge in behavioral voice therapy. Patients commonly encounter difficulties with practicing and implementing target voice techniques outside of the clinic. Several mobile support strategies have been shown to improve adherence. These strategies are driven by social cognitive theory, which provides a theoretical but practical framework for understanding adherence behavior and solving adherence problems. Key features of the theory include (1) its model of triadic asymmetrical reciprocal causation, (2) the concept of human agency, and (3) the constructs of self-efficacy and goal commitment. The purpose of this article is to (1) explain voice therapy adherence within the framework of social cognitive theory, (2) illustrate three broad categories of adherence problems, and (3) provide examples of strategies to address each. With this exemplified knowledge, the clinician can diagnose factors that underlie patients' adherence problems and develop individualized solutions. Given the significant role adherence plays in behavioral interventions, this information holds substantial clinical relevance.
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Affiliation(s)
- Eva van Leer
- Department of Communication Sciences and Disorders, Georgia State University, Atlanta, Georgia
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45
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Norwood C, Sabin-Farrell R, Malins S, Moghaddam NG. An explanatory sequential investigation of the working alliance as a change process in videoconferencing psychotherapy. J Clin Psychol 2021; 77:1330-1353. [PMID: 33482015 DOI: 10.1002/jclp.23112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/07/2020] [Accepted: 12/20/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES AND DESIGN Debate exists as to patient experience, and the importance, of the working alliance (WA) in videoconferencing psychotherapy (VCP). This study used a two-phase explanatory sequential design to investigate the WA as a change process in VCP. METHODS Phase I: sessional VCP outcome and WA data were analysed using multilevel modelling (n = 46). Phase II: participants (n = 12) from Phase I were recruited to semi-structured interviews, analysed using thematic framework analysis. RESULTS AND CONCLUSIONS Results demonstrate: (1) a significant correlation between WA and outcome (F(1, 15.19) = 25.01, p < 0.001), (2) previous session WA significantly predicted outcome in the next session (F(1, 355.61) = 4.47, p < 0.05), and (3) previous session outcome significantly predicted next session WA (F(1, 55.3) = 15.19, p < 0.001), with three core themes explaining patient experience (engaging with the medium, connection with the therapist, and working via the medium). Results are discussed and future research recommended.
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Affiliation(s)
- Carl Norwood
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Rachel Sabin-Farrell
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Sam Malins
- Institute of Mental Health, CLAHRC EM, University of Nottingham, Nottingham, UK
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Ekbäck E, Granåsen G, Svärling R, Blomqvist I, Henje E. Clinical Effectiveness of Training for Awareness Resilience and Action Online Compared to Standard Treatment for Adolescents and Young Adults With Depression: Study Protocol and Analysis Plan for a Pragmatic, Multi-Center Randomized Controlled Superiority Trial. Front Psychiatry 2021; 12:674583. [PMID: 34707516 PMCID: PMC8542661 DOI: 10.3389/fpsyt.2021.674583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/10/2021] [Indexed: 01/21/2023] Open
Abstract
Depression in adolescents and young adults is an increasing global health concern. Available treatments are not sufficiently effective and relapse rates remain high. The novel group-treatment program "Training for Awareness, Resilience and Action" (TARA) targets specific mechanisms based on neuroscientific findings in adolescent depression. TARA is framed within the National Institute of Mental Health's Research Domain Criteria and has documented feasibility and preliminary efficacy in the treatment of adolescent depression. Since neurodevelopment continues well into the mid-twenties, age-adapted treatments are warranted also for young adults. Patients 15-22 years old, with either major depressive disorder (MDD) or persistent depressive disorder (PDD) according to the DSM-IV/5 or a rating >40 on the clinician rating scale Children's Depression Rating Scale-Revised (CDRS-R), will be recruited from specialized Child and Adolescent Psychiatry and local Youth-Clinics and randomized to either TARA or standard treatment, including but not limited to antidepressant medication and/or psychotherapy. Outcome measures will be obtained before randomization (T0), after 3 months of treatment (T1) and at 6-months- (T2) and 24-months- (T3) follow-up. Additionally, dose-response measures will be obtained weekly in the TARA-arm and measures for mediation-analysis will be obtained halfway through treatment (T0.5). Primary outcome measure is Reynolds Adolescent Depression Scale (RADS-2) score at T1. Secondary outcome measures include RADS-2 score at T2, Multidimensional Anxiety Scale for Children at T1 and T2, and CDRS-R at T1. Additional outcome measures include self-report measures of depression-associated symptoms, systemic bio-indicators of depression from blood and hair, heartrate variability, brain magnetic resonance imaging, as well as three-axial accelerometry for sleep-objectivization. Qualitative data will be gathered to reach a more comprehensive understanding of the factors affecting adolescents and young adults with depression and the extent to which the different treatments address these factors. In summary, this article describes the design, methods and statistical analysis plan for pragmatically evaluating the clinical effectiveness of TARA. This will be the first RCT to examine the effects of TARA compared to standard treatment for adolescents and young adults with MDD or PDD. We argue that this study will extend the current knowledgebase regarding the treatment of depression. NCT Registration: identifier [NCT04747340].
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Affiliation(s)
- Erik Ekbäck
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Gabriel Granåsen
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Rachel Svärling
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Ida Blomqvist
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Eva Henje
- Department of Clinical Science, Umeå University, Umeå, Sweden
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47
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Hauber K, Boon A, Vermeiren R. Therapeutic Relationship and Dropout in High-Risk Adolescents' Intensive Group Psychotherapeutic Programme. Front Psychol 2020; 11:533903. [PMID: 33329172 PMCID: PMC7728845 DOI: 10.3389/fpsyg.2020.533903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022] Open
Abstract
Objective Dropout rates are a prominent problem in youth psychotherapy. An important determinant of dropouts is the quality of the therapeutic relationship. This study aimed to evaluate the association between the therapeutic relationship and dropouts in an intensive mentalization-based treatment (MBT) for adolescents with personality disorders. Methods Patients (N = 105) included were either dropouts (N = 36) or completers (N = 69) of an intensive MBT. The therapeutic relationship was measured with the child version of the Session Rating Scale (C-SRS), which was completed by the patient after each group therapy session. For each patient, the treatment termination status (dropout or completer) was indicated by the treatment staff. The reliable change index (RCI) was calculated for the C-SRS to determine significant changes in the therapeutic relationship. Results While both groups started with similar scores on the C-SRS, the scores between dropouts and completers differed significantly at the end of the treatment period. On average, during therapy, an increase was seen in the scores of completers, and a decrease was seen in the scores of dropouts. While dropouts could not be predicted based on the C-SRS scores, a significant decrease (RCI) in C-SRS scores during the last two sessions occurred more often for dropouts than for completers. Conclusion Our findings show that to prevent dropouts, the patient’s judgment of the quality of the therapeutic relationship should be monitored continuously, and decreases discussed with the patient and the group.
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Affiliation(s)
- Kirsten Hauber
- Curium-LUMC, Oegstgeest, Netherlands.,Youz, The Hague, Netherlands
| | - Albert Boon
- Curium-LUMC, Oegstgeest, Netherlands.,Youz, The Hague, Netherlands
| | - Robert Vermeiren
- Curium-LUMC, Oegstgeest, Netherlands.,Youz, The Hague, Netherlands
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48
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Tymofiyeva O, Henje E, Yuan JP, Huang CY, Connolly CG, Ho TC, Bhandari S, Parks KC, Sipes BS, Yang TT, Xu D. Reduced anxiety and changes in amygdala network properties in adolescents with training for awareness, resilience, and action (TARA). Neuroimage Clin 2020; 29:102521. [PMID: 33316764 PMCID: PMC7735968 DOI: 10.1016/j.nicl.2020.102521] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022]
Abstract
Mindfulness-based approaches show promise to improve emotional health in youth and may help treat and prevent adolescent depression and anxiety. However, there is a fundamental gap in understanding the neural reorganization that takes place as a result of such interventions. The Training for Awareness, Resilience, and Action (TARA) program, initially developed for depressed adolescents, uses a framework drawn from neuroscience, mindfulness, yoga, and modern psychotherapeutic techniques to promote emotional health. The goal of this study was to assess the effects of the TARA training on emotional health and structural white matter brain networks in healthy youth. We analyzed data from 23 adolescents who underwent the 12-week TARA training in a controlled within-subject study design and whose brain networks were assessed using diffusion MRI connectomics. Compared to the control time period, adolescents showed a significant decrease in anxiety symptoms with TARA (Cohen's d = -0.961, p = 0.006); moreover, the node strength of the Right Amygdala decreased significantly after TARA (Cohen's d = -1.026, p = 0.004). Post-hoc analyses indicated that anxiety at baseline before TARA was positively correlated with Right Amygdala node strength (r = 0.672, p = 0.001). While change in Right Amygdala node strength with TARA was not correlated with change in anxiety (r = 0.146, p = 0.51), it was associated with change in depression subscale of Anhedonia / Negative Affect (r = 0.575, p = 0.004, exploratory analysis), possibly due to overlapping constructs captured in our anxiety and depression scales. Our results suggest that increased structural connectivity of Right Amygdala may underlie increased anxiety in adolescents and be lowered through anxiety-reducing training such as TARA. The results of this study contribute to our understanding of the neural mechanisms of TARA and may facilitate neuroscience-based prevention and treatment of adolescent anxiety and depression.
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Affiliation(s)
- Olga Tymofiyeva
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 1700 4th Street, BH102, San Francisco, CA 94143, USA.
| | - Eva Henje
- Department of Psychiatry and Behavioral Sciences, The Langley Porter Psychiatric Institute, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Clinical Science/Child- and Adolescent Psychiatry, Umeå University, SE-901 87 Umeå, Sweden
| | - Justin P Yuan
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 1700 4th Street, BH102, San Francisco, CA 94143, USA; Department of Psychology, Stanford University, 450 Jane Stanford Way, Bldg 420, Jordan Hall, Stanford, CA 94305-2130, USA
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA 94143, USA
| | - Colm G Connolly
- Department of Psychiatry and Behavioral Sciences, The Langley Porter Psychiatric Institute, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Biomedical Sciences, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL 32306, USA
| | - Tiffany C Ho
- Department of Psychiatry and Behavioral Sciences, The Langley Porter Psychiatric Institute, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Sarina Bhandari
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 1700 4th Street, BH102, San Francisco, CA 94143, USA
| | - Kendall C Parks
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 1700 4th Street, BH102, San Francisco, CA 94143, USA
| | - Benjamin S Sipes
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 1700 4th Street, BH102, San Francisco, CA 94143, USA
| | - Tony T Yang
- Department of Psychiatry and Behavioral Sciences, The Langley Porter Psychiatric Institute, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Duan Xu
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 1700 4th Street, BH102, San Francisco, CA 94143, USA
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49
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Chung J, Buchanan B. A Self‐Report Survey: Australian Clinicians’ Attitudes Towards Progress Monitoring Measures. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ben Buchanan
- School of Psychological Sciences, Monash University
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50
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Haan AM, Boon AE, Jong JT, Geluk CA, Vermeiren RR. Therapeutic relationship and dropout in youth mental health care with ethnic minority children and adolescents. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anna M. Haan
- Youth Mental Health Care Centre, Scientific Research Department, Stichting De Jutters, The Hague, The Netherlands,
| | - Albert E. Boon
- Youth Mental Health Care Centre, Scientific Research Department, Stichting De Jutters, The Hague, The Netherlands,
- Centre for Orthopsychiatry and Forensic Youth Psychiatry, Scientific Research Department, De Fjord Lucertis, Capelle aan den IJssel, The Netherlands,
- Department of Child and Adolescent Psychiatry, Curium‐ Leiden University Medical Centre, Oegstgeest, The Netherlands,
| | - Joop T.v.M. Jong
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands,
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA,
- Department of Psychology, Rhodes University, Grahamstown, South Africa,
| | - Charlotte A.m.L. Geluk
- Department of Child and Adolescent Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands,
| | - Robert R.j.M. Vermeiren
- Department of Child and Adolescent Psychiatry, Curium‐ Leiden University Medical Centre, Oegstgeest, The Netherlands,
- Department of Child and Adolescent Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands,
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