1
|
Mejía-Castrejón J, Sierra-Madero JG, Belaunzarán-Zamudio PF, Fresan-Orellana A, Molina-López A, Álvarez-Mota AB, Robles-García R. Development and content validity of EVAD: A novel tool for evaluating and classifying the severity of adverse events for psychotherapeutic clinical trials. Psychother Res 2024; 34:475-489. [PMID: 37552872 DOI: 10.1080/10503307.2023.2239448] [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: 10/20/2022] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE Develop and obtain content validity of a new tool for Evaluating and Classifying the Severity of Adverse Events for Psychotherapeutic Clinical Trials (EVAD). METHOD Study of the development process of EVAD in four stages: (1) identify the domain and concept definition through a literature review, (2) instrument design, (3) expert judgment of the EVAD items through Gwent's concordance coefficient, and (4) applicability. RESULTS In the absence of a consistent conceptual framework of adverse events in psychotherapeutic clinical trials, we have developed a framework and defined it. We have designed EVAD items and their complementary tool for rating adverse events. Content validation by expert judges resulted in CVR = 1.0 for each item and CVI = 0.79 in sufficiency, 0.76 in clarity, 0.91 in coherence and 0.95 in relevance for all items (p < 0.001). Final version of EVAD were applied to three participants for 7 weeks. Overall EVAD seems to be clear and meaningful for participants. CONCLUSIONS EVAD is a semistructured interview based on a consistent conceptual framework, and proven content validity following the most important guidelines described in the literature. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03878186.
Collapse
Affiliation(s)
- Jessica Mejía-Castrejón
- Medical, Dental and Health Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Juan Gerardo Sierra-Madero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | | | - Ana Fresan-Orellana
- Subdirectorate of Clinical Research, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Alejandro Molina-López
- Outpatient Clinic, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Atenea Betzabé Álvarez-Mota
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Rebeca Robles-García
- Center for Research on Global Mental Health, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| |
Collapse
|
2
|
Richter C, Rutschmann R, Romanczuk-Seiferth N. Few negative effects of psychotherapy in a psychiatric day hospital: a follow-up survey to a multiprofessional treatment with acceptance and commitment therapy. Front Psychiatry 2024; 15:1235067. [PMID: 38389983 PMCID: PMC10881704 DOI: 10.3389/fpsyt.2024.1235067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024] Open
Abstract
While there are many studies on psychotherapy and its efficacy - in terms of desired outcomes - there is comparatively little evidence on the possible negative effects of psychotherapy. The aim of this study was to investigate the possible negative effects of a multi-professional psychiatric day hospital treatment for patients with mental health disorders based on Acceptance and Commitment Therapy (ACT), including possible confounding factors. Fifty-one patients with a range of psychiatric diagnoses were assessed three months after an ACT-based psychiatric day hospital treatment. Questionnaires were used to measure negative effects of psychotherapy (INEP), subjective quality of life (WHOQOL-BREF), and symptomatology (BDI-II and SCL-90-R). Correlational analyses and group comparisons were performed to determine the relationship between the sum of reported negative effects on the one hand and symptomology, quality of life, and sociodemographic variables (gender, age, diagnosis, education) on the other hand. At least one negative effect out of a list of 18 possible effects was reported by 45% of participants, and 10% reported more than two. The number of negative effects reported correlates positively with symptomology and negatively with quality of life. The sum of reported negative effects does not correlate with age or gender and does not vary by education level and primary diagnosis. In the light of previous findings, patients included in this study showed lower rates of negative effects, both overall and at item level. Practical implications of these findings are discussed.
Collapse
Affiliation(s)
- Christoph Richter
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Kaulsdorf, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Ronja Rutschmann
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Kaulsdorf, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Berlin, Germany
- MSB Medical School Berlin, Department of Psychology, Berlin, Germany
| | - Nina Romanczuk-Seiferth
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Berlin, Germany
- MSB Medical School Berlin, Department of Psychology, Berlin, Germany
| |
Collapse
|
3
|
Wijnen J, Gordon NL, van 't Hullenaar G, Pont ML, Geijselaers MWH, Van Oosterwijck J, de Jong J. An interdisciplinary multimodal integrative healthcare program for depressive and anxiety disorders. Front Psychiatry 2023; 14:1113356. [PMID: 37426091 PMCID: PMC10326275 DOI: 10.3389/fpsyt.2023.1113356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Although multimodal interventions are recommended in patients with severe depressive and/or anxiety disorders, available evidence is scarce. Therefore, the current study evaluates the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program, delivered within a transdiagnostic framework, for patients with (comorbid) depressive and/or anxiety disorders. Methods Participants were 3,900 patients diagnosed with a depressive and/or anxiety disorder. The primary outcome was Health-Related Quality of Life (HRQoL) measured with the Research and Development-36 (RAND-36). Secondary outcomes included: (1) current psychological and physical symptoms measured with the Brief Symptom Inventory (BSI) and (2) symptoms of depression, anxiety, and stress measured with the Depression Anxiety Stress Scale (DASS). The healthcare program consisted of two active treatment phases: main 20-week program and a subsequent continuation-phase intervention (i.e., 12-month relapse prevention program). Mixed linear models were used to examine the effects of the healthcare program on primary/secondary outcomes over four time points: before start 20-week program (T0), halfway 20-week program (T1), end of 20-week program (T2) and end of 12-month relapse prevention program (T3). Results Results showed significant improvements from T0 to T2 for the primary variable (i.e., RAND-36) and secondary variables (i.e., BSI/DASS). During the 12-month relapse prevention program, further significant improvements were mainly observed for secondary variables (i.e., BSI/DASS) and to a lesser extent for the primary variable (i.e., RAND-36). At the end of the relapse prevention program (i.e., T3), 63% of patients achieved remission of depressive symptoms (i.e., DASS depression score ≤ 9) and 67% of patients achieved remission of anxiety symptoms (i.e., DASS anxiety score ≤ 7). Conclusion An interdisciplinary multimodal integrative healthcare program, delivered within a transdiagnostic framework, seems effective for patients suffering from depressive and/or anxiety disorders with regard to HRQoL and symptoms of psychopathology. As reimbursement and funding for interdisciplinary multimodal interventions in this patient group has been under pressure in recent years, this study could add important evidence by reporting on routinely collected outcome data from a large patient group. Future studies should further investigate the long-term stability of treatment outcomes after interdisciplinary multimodal interventions for patients suffering from depressive and/or anxiety disorders.
Collapse
Affiliation(s)
- Jaap Wijnen
- Intergrin Academy, Geleen, Netherlands
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | | | | | | | | | - Jessica Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Center for InterProfessional Collaboration in Education Research and Practice (IPC-ERP UGent), Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | |
Collapse
|
4
|
Brakemeier EL, Guhn A, Stapel S, Reinhard MA, Padberg F. [Inpatient psychotherapy of depressive disorders: options and challenges]. DER NERVENARZT 2023; 94:213-224. [PMID: 36853327 DOI: 10.1007/s00115-023-01448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The psychotherapy of depressive disorders has become established as a central component of inpatient treatment in psychiatric and psychosomatic hospitals and furthermore constitutes an important component of the residency training in Germany; however, the number of studies examining the effectiveness and efficacy is limited. METHODS This narrative review summarizes the current state of research on inpatient psychotherapy for depressive disorders. The results of meta-analyses as well as practice-based observational studies from routine treatment in Germany, disorder-specific special programs, and side effects of inpatient psychotherapy are summarized. RESULTS The number of studies on the efficacy of inpatient psychotherapy of depressive disorders is overall low. The main finding of the largest recent meta-analysis indicates that psychotherapy in clinics and other facilities has a significant effect on depressive symptoms, with small to moderate effect sizes in randomized controlled studies. The effects are mostly maintained even after 9-15 months follow-up. An observational study from routine treatment with a very large sample size reported large pre-post and pre-follow-up effect sizes. It additionally revealed factors that appear to be difficult to change during inpatient psychotherapy, negatively affect treatment success and could be specifically addressed in future trials. Special programs, such as inpatient Interpersonal Psychotherapy (IPT) and the inpatient Cognitive Behavioral Analysis System of Psychotherapy (CBASP) indicate acceptance and efficacy/effectiveness in an initial randomized controlled (IPT) study and in observational (CBASP) studies. Side effects of inpatient psychotherapy were reported by 60-94% of patients with depressive disorders, whereby a perceived dependence on the therapist or the therapeutic setting was identified as a frequent side effect. CONCLUSION Overall, the results of the narrative review reveal that inpatient psychotherapy appears to be meaningful and effective for many patients with depressive disorders. Specific side effects, cost-effectiveness, and the question of differential indications (what works for whom?) should be further investigated.
Collapse
Affiliation(s)
- Eva-Lotta Brakemeier
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Greifswald, Greifswald, Deutschland.
| | - Anne Guhn
- Charité - Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Berlin, Deutschland
| | | | - Matthias A Reinhard
- Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, München, Deutschland
| | - Frank Padberg
- Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, München, Deutschland
| |
Collapse
|
5
|
Fazhan C, Liang L, Xudong Z, Qiang F, Congcong G, Yunhan Z. The preliminary development and psychometric properties of the Psychotherapy Side Effects Scale. Brain Behav 2023; 13:e2885. [PMID: 36621871 PMCID: PMC9927831 DOI: 10.1002/brb3.2885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 12/08/2022] [Accepted: 12/24/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Side effects in psychotherapy are common and have a negative impact on patients or clients. However, effective evaluation tools are still lacking and have not been fully studied. The present study aims to develop a scale with good reliability and validity to measure the side effects of psychotherapy. METHODS The 25 items in the Psychotherapy Side Effects Scale (PSES) were condensed and distributed to 420 subjects online to test its psychometric properties. RESULTS The internal consistency of the PSES was satisfactory to excellent (Cronbach's ɑ coefficient was .95, and the Guttman split-half coefficient was 0.88). A statistically significant negative correlation between the satisfaction score and the total score of the PSES was shown (r = -0.51, p < .001). The PSES could effectively discriminate between two groups with and without side effects (F = 250.95, p < .001) and was able to predict the occurrence of side effects in psychotherapy with an area under curve of 0.932 and a 95% confidence interval of 0.900-0.964 (p < .001). A cutoff was set at 36 points in total PSES score, from which the maximum Youden's index (= 0.72) could be obtained. The positive rate of the PSES was 24% (101/420). CONCLUSION The PSES showed good internal consistency, content validity, concurrent validity, discriminant validity and predictive validity in evaluating and identifying side effects in psychotherapy. More advanced reliability testing methods and structural validity testing for PESE need to be practiced in the future to better serve clinical practice.
Collapse
Affiliation(s)
- Chen Fazhan
- Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, P.R. China
| | - Liu Liang
- Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, P.R. China
| | - Zhao Xudong
- Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, P.R. China.,Department of Clinical Psychology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, P.R. China
| | - Feng Qiang
- Department of Clinical Psychology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, P.R. China
| | - Ge Congcong
- Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, P.R. China
| | - Zhao Yunhan
- Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, P.R. China
| |
Collapse
|
6
|
Glanert S, Sürig S, Grave U, Fassbinder E, Schwab S, Borgwardt S, Klein JP. Investigating Care Dependency and Its Relation to Outcome (ICARE): Results From a Naturalistic Study of an Intensive Day Treatment Program for Depression. Front Psychiatry 2021; 12:644972. [PMID: 34737714 PMCID: PMC8562106 DOI: 10.3389/fpsyt.2021.644972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/10/2021] [Indexed: 12/30/2022] Open
Abstract
Background: This study explores the association of experienced dependency in psychotherapy as measured with the CDQ (Care Dependency Questionnaire) and treatment outcome in depression. Furthermore, the course of care dependency and differences in the CDQ scores depending on the received type of treatment, MCT (metacognitive therapy), or CBASP (cognitive behavioral analysis system of psychotherapy), were investigated. Methods: The study follows a prospective, parallel group observational design. Patients suffering from depression received an 8-week intensive day clinic program, which was either CBASP or MCT. The treatment decision was made by clinicians based on the presented symptomatology and with regard to the patients' preferences. The patients reported depressive symptoms with the QIDS-SR16 (Quick Inventory of Depressive Symptomatology) and levels of experienced care dependency with the German version of the CDQ on a weekly basis. Mixed-model analyses were run to account for the repeated-measures design. Results: One hundred patients were included in the analyses. Results indicate that higher levels of care dependency might predict a less favorable outcome of depressive symptomatology. Levels of care dependency as well as depressive symptoms decreased significantly over the course of treatment. There was no significant between-group difference in care dependency between the two treatment groups. Conclusion: The results suggest that care dependency might be associated with a worse treatment outcome in depressed patients. In general, care dependency seems to be a dynamic construct, as it is changing over time, while the levels of care dependency seem to be independent from the received type of treatment. Future research should continue investigating the mechanisms of care dependency in a randomized controlled design. Clinical Trial Registration: https://www.drks.de/drks_web/, identifier: DRKS00023779.
Collapse
Affiliation(s)
- Sarah Glanert
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Svenja Sürig
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Ulrike Grave
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.,Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Sebastian Schwab
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| |
Collapse
|