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Hill CE, Norcross JC. Skills and methods that work in psychotherapy: Observations and conclusions from the special issue. Psychotherapy (Chic) 2023; 60:407-416. [PMID: 37036683 DOI: 10.1037/pst0000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
We draw recommendations and conclusions from the articles presented in this special issue and the companion special section in Psychotherapy Research on evidence-based therapist skills and methods. For distal (end-of-treatment) outcome, 10 skills/methods were judged to be demonstrably effective (affirmation/validation, paradoxical interventions, homework, routine outcome monitoring, strength-based methods, emotional regulation, imagery rehearsal therapy and exposure relaxation and rescripting therapy for nightmares, meditation/mindfulness/acceptance, behavioral activation, cognitive restructuring) and four were probably effective (rupture repair, role induction, collaborative assessment methods, chairwork). For intermediate (postsession or midtreatment) outcome, one method was judged to be demonstrably effective (cognitive-experiential dreamwork) and two methods probably effective (paradoxical interventions, homework). For immediate (in-session) outcomes, five skills/methods were judged to be probably effective (in-dialog silences, extended silences, role induction, strength-based methods, and emotion regulation). For the rest of the immediate, intermediate, or distal outcomes for skills/methods, there was either no or insufficient research available upon which to base judgments. Possible harmful effects, diversity considerations, and research limitations are summarized. The article ends with training implications, therapeutic practices, and the formal conclusions of the interorganizational Task Force on Psychotherapy Skills and Methods that Work. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Clara E Hill
- Department of Psychology, University of Maryland
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Affiliation(s)
- Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto
| | - Wade Thompson
- Women's College Research Institute, Toronto
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | | | - Deborah Brown
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto
| | - Barbara Liu
- Division of Geriatric Medicine, Department of Medicine, University of Toronto
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Zhang L, Li Y, Kou W, Xia Y, Yu X, Du X. Reminiscence therapy exhibits alleviation of anxiety and improvement of life quality in postoperative gastric cancer patients: A randomized, controlled study. Medicine (Baltimore) 2021; 100:e26821. [PMID: 34477119 PMCID: PMC8415997 DOI: 10.1097/md.0000000000026821] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/25/2021] [Accepted: 07/16/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Although reminiscence therapy alleviates mental illness and improves quality of life in neurocognitive disorders patients, little study reports its clinical application in cancer patients. Thus, this study aimed to explore the effect of reminiscence therapy on anxiety, depression, quality of life, and survival profile in postoperative gastric cancer patients.One hundred sixty surgical gastric cancer patients were enrolled in this randomized, controlled study, then randomly assigned to Reminiscence therapy group (N = 80) and Control group (N = 80) as 1:1 ratio. The evaluation was carried at baseline (M0), month 3 (M3), month 6 (M6), month 9 (M9), and month 12 (M12) after intervention by Hospital Anxiety and Depression Scale and European Organization for Research and Treatment of Cancer quality of life Questionnaire-Core 30 (QLQ-C30). Furthermore, disease-free survival and overall survival were analyzed using follow-up data.Reminiscence therapy decreased HADS for anxiety score at M6, M9, and M12, decreased anxiety rate at M9 and M12 compared to control care; while it did not affect HADS for depression score or depression rate at any time-point. Also, reminiscence therapy raised QLQ-C30 global health status score at M12, reduced QLQ-C30 symptoms score at M6, while did not affect QLQ-C30 function score at any time-point compared to control care. Reminiscence therapy did not affect disease-free survival and overall survival, either. Further subgroup analyses (divided by age and gender) observed that the effect of reminiscence therapy seemed more obvious in patients with age ≤60 years and male patients.Reminiscence therapy exhibits alleviation of anxiety and improvement of quality of life in postoperative gastric cancer patients.
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Affiliation(s)
- Lisha Zhang
- Department of Gastrointestinal Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - Yanling Li
- Department of Gastrointestinal Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - Wenjia Kou
- Department of Gastrointestinal Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - Yue Xia
- Department of Gastrointestinal Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiaohui Yu
- Department of Gastrointestinal Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - Xin Du
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Padberg I, Heel S, Thiem P, Diebel A, Mordhorst E, Strohmeyer U, Meisel A. Quality measurement of out-patient neuropsychological therapy after stroke in Germany: definition of indicators and retrospective pilot study. BMC Neurol 2021; 21:76. [PMID: 33596841 PMCID: PMC7888117 DOI: 10.1186/s12883-021-02092-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 02/04/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In contrast to the hospital setting, today little work has been directed to the definition, measurement, and improvement of the quality of out-patient medical and therapeutic care. We developed a set of indicators to measure the quality of out-patient neuropsychological therapy after stroke. METHODS The indicators cover core and interdisciplinary aspects of out-patient neuropsychological work such as mediation of patients into social care in case of need. Selection of the quality-indicators was done together with a consensus group of out-patient therapists and supported by evidence, validity, reliability as well as estimated relevance and variability with the quality of care. The set of indicators was further tested in a retrospective cohort study. Anonymous data of 104 patients were collected from out-patient clinical records of five clinics between November 2017 and April 2018. Associations between process and outcome quality were estimated exploitatively. RESULTS Results allowed for the identification of areas with greater variability in the quality of process care and indicated that attention training as recommended by current guidelines had the lowest overall rate for meeting the quality-aim (met in 44% of the cases). This was followed by time < 1 month until the start of therapy (63% met) and mediation into social care in case of need (65% met). We further observed that overall quality and involving relatives in the therapy was associated with higher rates of professional reintegration (p-value = 0.03). However, the need for mediation into social care was associated with a reduced chance for successful professional reintegration (p-value = 0.009). CONCLUSION In conclusion, we describe a first set of quality indicators which cover different aspects of out-patient neuropsychological therapy and sufficient variability with care. First data further suggests that meeting the specified quality aims may indeed have relevant effects on outcomes.
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Affiliation(s)
- I Padberg
- Center for Stroke Research, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | - S Heel
- Zentrum für ambulante Neuropsychologie und Verhaltenstherapie (Center for out-patient neuropsychology and behavioral therapy), Schleiermacherstraße 24, 10961, Berlin, Germany
| | - P Thiem
- P.A.N.P - Praxis für ambulante Neuropsychologie Potsdam (out-patient clinic for neuropsychology Potsdam), Ludwig-Richter-Straße 23, 14467, Potsdam, Germany
| | - A Diebel
- Praxis Diebel (out-patient clinic Diebel), Oldenburger Straße 30, 10551, Berlin, Germany
| | - E Mordhorst
- Zentrum für ambulante Rehabilitation (Center for out-patient rehabilitation) ZAR Berlin, Gartenstraße 5, 10115, Berlin, Germany
| | - U Strohmeyer
- Praxis für ambulante Neuropsychologie und Psychotherapie (out-patient clinic for neuropsychology and psychotherapy), Wilmersdorfer Str. 125, 10627, Berlin, Germany
| | - A Meisel
- Center for Stroke Research, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Marzani G, Price Neff A. Bipolar Disorders: Evaluation and Treatment. Am Fam Physician 2021; 103:227-239. [PMID: 33587568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Bipolar disorders are common, recurrent mental health conditions of variable severity that are difficult to diagnose. Affected individuals have higher rates of other mental health disorders, substance use disorders, and comorbid chronic medical illnesses. New diagnostic criteria and specifiers with attention on mixed features and anxious distress aid the physician in recognizing episode severity and prognosis. Physicians should consider bipolar disorder in any patient presenting with depression. Pharmacotherapy with mood stabilizers, such as lithium, anticonvulsants, and antipsychotics, is a first-line treatment that should be continued indefinitely because of the risk of patient relapse. Active lifestyle approaches include good nutrition, exercise, sleep hygiene, and proper weight management. Monotherapy with antidepressants is contraindicated during episodes with mixed features, manic episodes, and in bipolar I disorder. Ongoing management involves monitoring for suicidal ideation, substance use disorders, treatment adherence, and recognizing medical complications of pharmacotherapy. Psychotherapy is a useful adjunct to pharmacotherapy. Patients and their support systems should be educated about the chronic nature of this illness, possible relapse, suicidality, environmental triggers (e.g., seasonal light changes, shift work, other circadian disruption), and the effectiveness of early intervention to reduce complications.
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Pace BT, Kuo PB, Tao KW, Owen J, Van Epps J, Davies DR, Imel ZE. Determining the therapist's contribution in therapist multicultural competence process and outcome. J Couns Psychol 2020; 68:149-155. [PMID: 33252919 DOI: 10.1037/cou0000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Efforts to help therapists improve their multicultural competence (MCC) rely on measures that can distinguish between different levels of competence. MCC is often assessed by asking clients to rate their experiences with their therapists. However, differences in client ratings of therapist MCC do not necessarily provide information about the relative performance of therapists and can be influenced by other factors including the client's own characteristics. In this study, we used a repeated measures design of 8,497 observations from 1,458 clients across 35 therapists to clarify the proportion of variability in MCC ratings attributed to the therapist versus the client and better understand the extent that an MCC measure detects therapist differences. Overall, we found that a small amount of variability in MCC ratings was attributed to the therapist (2%) and substantial amount attributed to the client (70%). These findings suggest that our measure of MCC primarily detected differences at the client level versus therapist level, indicating that therapist MCC scores were largely dependent on the client. Clinical implications and recommendations for future MCC research and measurement are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Falkenström F, Solomonov N, Rubel JA. Do therapist effects really impact estimates of within-patient mechanisms of change? A Monte Carlo simulation study. Psychother Res 2020; 30:885-899. [PMID: 32482144 PMCID: PMC7526345 DOI: 10.1080/10503307.2020.1769875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022] Open
Abstract
Objective: Existing evidence highlights the importance of modeling differential therapist effectiveness when studying psychotherapy outcome. However, no study to date examined whether this assertion applies to the study of within-patient effects in mechanisms of change. The study investigated whether therapist effects should be modeled when studying mechanisms of change on a within-patient level. Methods: We conducted a Monte Carlo simulation study, varying patient- and therapist level sample sizes, degree of therapist-level nesting (intra-class correlation), balanced vs. unbalanced assignment of patients to therapists, and fixed vs random within-patient coefficients. We estimated all models using longitudinal multilevel and structural equation models that ignored (2-level model) or modeled therapist effects (3-level model). Results: Across all conditions, 2-level models performed equally or were superior to 3-level models. Within-patient coefficients were unbiased in both 2- and 3-level models. In 3-level models, standard errors were biased when number of therapists was small, and this bias increased in unbalanced designs. Ignoring random slopes led to biased standard errors when slope variance was large; but 2-level models still outperformed 3-level models. Conclusions: In contrast to treatment outcome research, when studying mechanisms of change on a within-patient level, modeling therapist effects may even reduce model performance and increase bias.
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Affiliation(s)
- Fredrik Falkenström
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
| | - Julian A Rubel
- Department of Psychology, Justus Liebig University Giessen, Giessen, Germany
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Youssef NA, Aquadro E, Thomas A, Brown S, O'Connor K, Hobbs J, Bishnoi RJ. A primary care guide to bipolar depression treatment. J Fam Pract 2020; 69:344-352. [PMID: 32936843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Manage uncomplicated cases following guidelines on medical therapy and with adjunctive psychotherapy. Refer complicated and severe cases to Psychiatry.
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Affiliation(s)
- Nagy A Youssef
- Department of Psychiatry and Health Behavior, Office of Academic Affairs, Medical College of Georgia at Augusta University, Augusta, USA.
| | - Emily Aquadro
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, USA
| | - Andria Thomas
- Office of Academic Affairs, Medical College of Georgia at Augusta University, Augusta, USA
| | - Shilpa Brown
- Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, USA
| | - Kate O'Connor
- Department of Pharmacy, Augusta University Health, GA, USA
| | - Joseph Hobbs
- Department of Family Medicine, Medical College of Georgia at Augusta University, Augusta, USA
| | - Ram J Bishnoi
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, USA
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Carretier E, Grau L, Mansouri M, Moro MR, Lachal J. Qualitative assessment of transcultural psychotherapy by adolescents and their migrant families: Subjective experience and perceived effectiveness. PLoS One 2020; 15:e0237113. [PMID: 32760157 PMCID: PMC7410290 DOI: 10.1371/journal.pone.0237113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/20/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Adolescent migrants present psychological disorders more frequently than the corresponding host population but their access to care and to follow-up are less effective. The French method of transcultural psychotherapy (TPT) was conceived to respond to these problems. Our objective is to assess how these adolescents and their families perceive the experience and effectiveness of TPT. METHOD We conducted semistructured interviews with the families of adolescents seen for TPT. The data were analyzed by a qualitative thematic methodology. RESULTS We spoke to 21 participants in 8 families. The families came to TPT with a sense that the teen's current treatment was at an impasse. During the follow-up, they noted that family communication and relationships had improved, as had their connection to their culture of origin. Besides commenting on what they perceived as limitations, families identified specific elements of TPT as therapeutic. CONCLUSION The pronounced diversity of the group and the use of both multiperspective narration and an interpreter were specific elements driving the construction of a good therapeutic alliance, despite the initial barriers. Pursuit of the evaluation of TPT is essential to advance the psychiatric care of adolescent migrants.
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Affiliation(s)
- Emilie Carretier
- Maison de Solenn, Cochin Hospital, Paris, France
- Inserm, Centre de Recherche en Epidémiologie et Santé des Populations, Team DevPsy, Paris-Saclay University, Villejuif, France
| | - Léa Grau
- Unité Transversale de Recherche Psychogenèse et Psychopathologie, Paris 13 University, Villetaneuse, France
| | | | - Marie Rose Moro
- Maison de Solenn, Cochin Hospital, Paris, France
- Inserm, Centre de Recherche en Epidémiologie et Santé des Populations, Team DevPsy, Paris-Saclay University, Villejuif, France
| | - Jonathan Lachal
- Maison de Solenn, Cochin Hospital, Paris, France
- Inserm, Centre de Recherche en Epidémiologie et Santé des Populations, Team DevPsy, Paris-Saclay University, Villejuif, France
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Dockweiler C, Kupitz A, Palmdorf S, Hornberg C. [Online therapy for depressive disorders : An acceptance-based analysis from the perspective of therapists]. Nervenarzt 2020; 91:243-251. [PMID: 31165209 DOI: 10.1007/s00115-019-0730-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The supply of online therapy options for mild to moderate depressive disorders has substantially risen both nationally and internationally in the past years. While the efficacy and efficiency of specific online-based therapeutic services were indicated within the framework of scientific evaluations, little is known about the acceptance of these new therapy options. METHODS In a nationwide online survey of online-based therapy options for mild to moderate depressive disorders, the attitude and stance as well as the use intention and the subjectively perceived knowledge of 657 medical practitioners and therapists, active in psychotherapeutic and psychiatric treatment were collated. The impact of the potential predictors on the use intention of online-based therapies, based on the unified theory of acceptance and use of technology, was analyzed by means of a binary logistic regression model. RESULTS Besides the perceived performance and expense expectations, the supportive framework conditions, the influence of the cooperative environment, the individual technical affinity as well as the evaluation of the prospective significance of online-based therapy proved to be significantly influential predictors on the user intention. Special predictability for a positive user intention was shown related to the perceived potential of online therapy. CONCLUSION The results underline the relevance of further evidence-basing of online therapy for mild to moderate depressive disorders. A user-oriented, participatory technology development proves to be just as relevant as a comprehensive sensitization, elucidation and education of potential users for a successful implementation.
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Affiliation(s)
- Christoph Dockweiler
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstraße 25, 33501, Bielefeld, Deutschland.
| | - Anna Kupitz
- Deutsches Kinderschmerzzentrum, Universität Witten/Herdecke, Dr.-Friedrich-Steiner Str. 5, 45711, Datteln, Deutschland
| | - Sarah Palmdorf
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstraße 25, 33501, Bielefeld, Deutschland
| | - Claudia Hornberg
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstraße 25, 33501, Bielefeld, Deutschland
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Shankar R, El Kady R, Aggarwal A. Youth Suicide: A Population Crying for Help? A System Overloaded? Who Can Help? Mo Med 2020; 117:370-374. [PMID: 32848275 PMCID: PMC7431062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Suicide is the second leading cause of death in young adults (15-24 years old). There continues to be limited access to mental health services for many patients who are in mental health crisis because of shortage of trained psychiatrist and mental health providers. Patients identified with high risk factors should get a full comprehensive psychiatric evaluation. Management should focus on preventative strategies, early identification as well as treatment with appropriate psychopharmacology and psychotherapy.
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Affiliation(s)
- Ravi Shankar
- MSMA member since 2014, is Assistant Professor, Director for both Child & Adolescent Psychiatry Fellowship and Psychiatry Clerkship, Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
| | - Rasha El Kady
- Assistant Professor, Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
| | - Arpit Aggarwal
- Assistant Professor and Medical Director of the Psychiatric Center Assessment Unit, Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
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Shafran R, Bennett S, Coughtrey A, Welch A, Walji F, Cross JH, Heyman I, Sibelli A, Smith J, Ross J, Dalrymple E, Varadkar S, Moss-Morris R. Optimising Evidence-Based Psychological Treatment for the Mental Health Needs of Children with Epilepsy: Principles and Methods. Clin Child Fam Psychol Rev 2020; 23:284-295. [PMID: 31965422 PMCID: PMC7192863 DOI: 10.1007/s10567-019-00310-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There are potent evidence-based psychological treatments for youth with mental health needs, yet they are rarely implemented in clinical practice, especially for youth with mental health disorders in the context of chronic physical illness such as epilepsy. Implementation science, the study of the translation of research into practice, can promote the uptake of existing effective interventions in routine clinical practice and aid the sustainable integration of psychological treatments with routine health care. The aim of this report was to use four implementation science methods to develop a version of an existing effective psychological treatment for mental health disorders [the Modular Approach to Treatment of Children with Anxiety, Depression or Conduct Problems (MATCH-ADTC)] for use within paediatric epilepsy services: (a) literature search; (b) iterative focus groups underpinned by normalisation process theory; (c) Plan-Do-Study-Act methods; and (d) qualitative patient interviews. Findings: Three modifications were deemed necessary to facilitate implementation in children with both mental health disorders and epilepsy. These were (a) a universal brief psychoeducational component addressing the relationship between epilepsy and mental health; (b) supplementary, conditionally activated interventions addressing stigma, parental mental health and the transition to adulthood; and (c) additional training and supervision. The intervention needed relatively little alteration for implementation in paediatric epilepsy services. The modified treatment reflected the scientific literature and the views of clinicians and service users. The multi-method approach used in this report can serve as a model for implementation of evidence-based psychological treatments for children with mental health needs in the context of other chronic illnesses.
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Affiliation(s)
- Roz Shafran
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Sophie Bennett
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Anna Coughtrey
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Alice Welch
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Fahreen Walji
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - J Helen Cross
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Isobel Heyman
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Alice Sibelli
- Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, SE1 9RT, UK
| | | | - Jamie Ross
- Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Emma Dalrymple
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Sophia Varadkar
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Rona Moss-Morris
- Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, SE1 9RT, UK
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13
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Abstract
Background: The Session Rating Scale (SRS) is a measure used in psychotherapy practice. Given its application and frequent use in clinical practice settings, several studies including primary validation studies as well as outcome studies reporting psychometric properties have examined the validity and reliability of the SRS. Because the SRS is designed to be used in clinical practice, demonstration of reliability and validity is ideal with clinical populations instead of non-clinical populations. To our knowledge, there have been no reviews evaluating the psychometric properties of the SRS with clinical populations.Purpose: The aim of this study was to review and synthesize the psychometric properties of the SRS by examining all relevant outcome and validation studies.Methods: We completed an electronic literature search of several online databases in order to identify relevant articles. We identified 12 articles that met our inclusion and analyzed the reliability and validity evidence for the SRS with clinical populations.Results: Findings showed high internal consistency for the SRS and support evidence that the underlying dimension is a measure of therapeutic alliance. Test-retest reliability estimates were reported in 4 of the 12 studies included in this review (ranging from .54 to .70). The SRS had low to moderate concurrent validity with other longer measures of therapeutic alliance (.29 with ORS; .48 with HAQ II; .57-.65 with WAI).Discussion: Clinicians should be aware of the limitations in validity evidence for the SRS that may result from its brevity. However, clinicians should also consider the relative stability of the SRS as a pragmatic global measure of the construct of therapeutic alliance. Future research efforts should focus on validation of the SRS with larger, more diverse samples and specific clinical populations with a wider range of symptom severity.
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Affiliation(s)
- Melissa G Murphy
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Sarah Rakes
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Rachel M Harris
- College of Social Work, Florida State University, Tallahassee, Florida, USA
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Abstract
OBJECTIVE Chronic pain is a significant health problem that is increasing in prevalence, and advances in treatment are needed. METHODS We briefly review the leading evidence-based psychological therapies for chronic pain-cognitive-behavioral and acceptance/mindfulness-based therapies-and examine several limitations and missing perspectives of these approaches. We review six lesser-known interventions that address these limitations, and we describe our integrative model for psychological assessment and treatment of centralized pain. We present a typical patient and describe how we apply this approach, along with challenges to its implementation and possible solutions to these challenges. RESULTS Greater pain treatment efficacy may be possible if clinicians: (a) distinguish patients with primarily centralized (i.e., somatoform or nociplastic) pain from those with primarily peripheral (nociceptive, inflammatory, or neuropathic) pain; (b) acknowledge the capacity of the brain not only to modulate pain but also generate as well as attenuate or eliminate centralized pain; (c) consider the powerful role that adverse life experiences and psychological conflicts play in centralized pain; and (d) integrate emotional processing and interpersonal changes into treatment. Our integrative treatment involves delivering a progression of interventions, as needed, to achieve pain reduction: tailored pain neuroscience education, cognitive and mindfulness skills to decrease the pain danger alarm mechanism, behavioral engagement in avoided painful and other feared activities, emotional awareness and expression to reverse emotional avoidance and overcome trauma or psychological conflict, and adaptive communication to decrease interpersonal stress. CONCLUSIONS This integrative assessment and treatment model has the potential to substantially reduce and sometimes eliminate centralized pain by changing the cognitive, behavioral, emotional, and interpersonal processes that trigger and maintain centralized pain.
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Affiliation(s)
- Mark A Lumley
- From the Department of Psychology (Lumley), Wayne State University, Detroit, Michigan; and Department of Internal Medicine (Schubiner), Providence-Providence Park Hospital, Ascension Health, and Michigan State University College of Human Medicine, Southfield, Michigan
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Springer P, Bischoff RJ, Kohel K, Taylor NC, Farero A. Collaborative Care at a Distance: Student Therapists' Experiences of Learning and Delivering Relationally Focused Telemental Health. J Marital Fam Ther 2020; 46:201-217. [PMID: 32277719 PMCID: PMC7262045 DOI: 10.1111/jmft.12431] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
There is mounting evidence that telemental health is an effective delivery method for treating a variety of mental, emotional, behavioral, and relational health problems. While many of the therapeutic skills leading to the effectiveness of face-to-face treatments are transferable, the effectiveness of telemental health requires unique skills. The purpose of this phenomenological study was to determine the experience of learning how to use videoconferencing to deliver relationally focused mental health care. Participants included 10 graduates of a COAMFTE-accredited master's degree program emphasizing training in telemental health. Each student had practicum placements that required videoconferencing to deliver relationally based psychotherapy. Analysis of interview data revealed (a) personal reservations about distance delivery; (b) the importance of scaffolding student learning through curriculum, supervision, and mental health-care delivery protocols; (c) the technological barriers associated with this delivery method; and (d) overcoming technological barriers through intentionality.
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Lu JY, Tung TH, Shen SA, Huang C, Chen PS. The effects of psychotherapy for depressed or posttraumatic stress disorder women with childhood sexual abuse history: Meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e19776. [PMID: 32332620 PMCID: PMC7220744 DOI: 10.1097/md.0000000000019776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Depression and posttraumatic stress disorder (PTSD) are the most common mental disorders of women suffered from childhood sexual abuse histories. It has been widely recognized that depression and PTSD may decrease patients' quality of life. The objective of this study is conducted to explore the effects of psychotherapy for depressed or PTSD women with childhood sexual abuse history. METHODS We searched the PubMed and Cochrane Library from inception to June 30, 2019. The search strategy is (sexual assault OR sexual crime OR sexual abuse) AND (depression OR PTSD) AND (treatment OR intervention OR psychotherapy) with no restriction on language. Two authors independently selected the studies, assessed the quality of the included studies, and extracted data. RESULTS Nine randomized control trials with 761 participants met the inclusion criteria. There were 340 participants in the psychotherapy group and 421 participants in the control group (usual treatment or waiting list). Compared to usual care, improvements were significantly greater in the psychotherapy group. The Beck depression inventory score for depression diagnosis of the psychotherapy group is lower from 4.27 to 8.96 (P < .05) than the control group. The client assessment protocols for PTSD, the diagnosis is also lower from 12.4 to 13.71 than the control group (P < .05). CONCLUSION The results suggested that psychotherapy is effective in reducing depressed or PTSD women with childhood sexual abuse. Further large-scale high-quality randomized controlled trials with long-term follow-up are warranted for confirming this finding.
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Affiliation(s)
- Jhih-Yuan Lu
- Taiwan Joint Commission on Hospital Accreditation, Taipei
- Department of Public Health, Kaohsiung Medical University, Kaohsiung
| | - Tao-Hsin Tung
- Department of Crime Prevention and Correction, Central Police University, Taoyuan
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei
| | - Sheng-Ang Shen
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei
- Department of Clinical Psychology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Chien Huang
- Department of Clinical Psychology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Pei-Shih Chen
- Department of Public Health, Kaohsiung Medical University, Kaohsiung
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Breilmann J, Kilian R, Riedel-Heller SG, Gühne U, Hasan A, Falkai P, Allgöwer A, Muche R, Becker T, Ajayi K, Brieger P, Frasch K, Heres S, Jäger M, Küthmann A, Putzhammer A, Schmauß M, Schneeweiß B, Schwarz M, Kösters M. Implementation of the patient version of the evidence-based (S3) guideline for psychosocial interventions for patients with severe mental illness (IMPPETUS): study protocol for a cluster randomised controlled trial. Trials 2020; 21:275. [PMID: 32183897 PMCID: PMC7079434 DOI: 10.1186/s13063-020-4200-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The German guideline on psychosocial interventions for people with severe mental disorders recommends a broad spectrum of evidence-based treatments. Structured implementation of the associated patient version of the guideline is missing to date. The study aims to assess whether structured implementation of a patient guideline improves the empowerment of patients with severe mental disorders, as well as knowledge, attitudes and experiences regarding psychosocial interventions, service use, treatment satisfaction, treatment needs, quality of life and burden of care. METHODS The study is a multicentre, cluster-randomised, controlled study with two parallel groups. Inpatients and day hospital patients (all sexes; 18-65 years) with severe mental disorders will be included. Additionally, relatives of patients with mental disorders (all sexes; ≥ 18 years) will be included. In the experimental group, the patient guideline will be implemented using a multimodal strategy. Participants in the control group will receive treatment as usual but will be made aware of the patient guideline. The primary outcome is the change of empowerment, assessed by using the 'empowerment in the process of psychiatric treatment of patients with affective and schizophrenia disorders' (EPAS) scale. In addition, knowledge, attitudes and experiences regarding psychosocial interventions will be assessed as secondary outcomes, as well as service use, satisfaction with care, patient need and quality of life and participation and social inclusion. For relatives, the perceived burden of care also will be recorded. Results will be analysed using hierarchical linear models. For the health economic evaluation, the incremental cost-utility ratios will be computed using the differences in total costs of illness and the differences in quality-adjusted life years (QALY) between study groups. DISCUSSION The study will be the first to assess the effects of a structured implementation of the patient version of a psychiatric treatment guideline. The study has some limitations regarding the transferability of the results to other patients and other regions. Furthermore, problems with the recruitment of patients and relatives and with the implementation of intervention could occur during the study. TRIAL REGISTRATION The study is registered in the German Clinical Trials Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00017577 (Date of registration: 23 October 2019.
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Affiliation(s)
- Johanna Breilmann
- Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
| | - Reinhold Kilian
- Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
| | - Andreas Allgöwer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Rainer Muche
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Thomas Becker
- Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
| | - Klemens Ajayi
- Kbo-Isar-Amper hospital, Haar, Taufkirchen, Munich, Germany
| | - Peter Brieger
- Kbo-Isar-Amper hospital, Haar, Taufkirchen, Munich, Germany
| | - Karel Frasch
- Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
- District hospital Donauwörth, Donauwörth, Germany
| | - Stephan Heres
- Kbo-Isar-Amper hospital, Haar, Taufkirchen, Munich, Germany
| | - Markus Jäger
- Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
- District hospital Kempten, Kempten, Germany
| | | | | | - Max Schmauß
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | | | | | - Markus Kösters
- Department of Psychiatry ll, Ulm University, Guenzburg, Bezirkskrankenhaus, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
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Stellungnahme zum Arbeitsentwurf des Bundesministeriums für Gesundheit – Approbationsordnung für Ärzte und Ärztinnen (ÄApprO) der DGKJP. Z Kinder Jugendpsychiatr Psychother 2020; 48:167-8. [PMID: 32162588 DOI: 10.1024/1422-4917/a000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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19
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Juckel G, Hegerl U. [Psychotherapy in psychiatry via digital media? For]. Nervenarzt 2020; 91:257-258. [PMID: 31444519 DOI: 10.1007/s00115-019-00785-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Georg Juckel
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum Bochum, Alexandrinenstr. 1-3, 44791, Bochum, Deutschland.
| | - Ulrich Hegerl
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Goethe-Universität Frankfurt, Frankfurt, Deutschland
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Löffler-Stastka H. [Psychotherapy in psychiatry via digital media? Against]. Nervenarzt 2020; 91:259-260. [PMID: 31440770 DOI: 10.1007/s00115-019-00786-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Henriette Löffler-Stastka
- Klinik für Psychoanalyse und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Brakemeier EL, Herpertz SC. [Innovative psychotherapy research: towards an evidence-based and process-based individualized and modular psychotherapy]. Nervenarzt 2019; 90:1125-1134. [PMID: 31659372 DOI: 10.1007/s00115-019-00808-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Psychotherapy has been proven to be effective; however, this statement applies in particular to the "average patient" in randomized controlled trials. As a considerable proportion of patients do not show any benefits despite the constant development of new therapy methods and the mechanisms of action are still too little understood, innovative psychotherapy research has to address both problems. In addition, the idea of personalization that originated in somatic medicine or - from our point of view more appropriately - individualization or person-centering should be taken up. After providing an overview of further developments in psychotherapy beyond disorder-specific methods, this article presents an evidence- and process-based individualized and modular psychotherapy as a visionary goal of psychotherapeutic research: Beyond syndromes and disorders, as many biopsychosocial characteristics as possible and the processes and mechanisms underlying the mental problems should be analyzed and bundled in an individual comprehensive functional analysis. Based on this functional analysis, evidence-based techniques and modules should be selected. The individual response during the course of therapy should be continuously documented, so that feedback helps to determine the further therapeutic procedure. In order to pursue this vision, studies are needed that are oriented towards the individual patient, investigate the central mechanisms of action and generate large translational datasets. These should be analyzed by ideographic analyses and reduce the gap between research and practice, thus contributing to the paradigm of a practice research network, which is now consistently moving to the centre of research.
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Affiliation(s)
- E-L Brakemeier
- Lehrstuhl Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Greifswald, Franz-Mehring-Straße 47, 17489, Greifswald, Deutschland.
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Gutenbergstr. 18, 35037, Marburg, Deutschland.
- Schön Klinik Bad Arolsen, Bad Arolsen, Deutschland.
| | - S C Herpertz
- Klinik für Allgemeine Psychiatrie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Blechinger T, Lundqvist S, Buchmayer S, Unenge Hallerbäck M, Jarbin H. [Dropout from Specialty Training is determined by the perception of autonomy and treatment efficacy]. Lakartidningen 2019; 116:FRHT. [PMID: 31454053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Swedish Association for Child and Adolescent Psychiatry conducted a survey among their specialty trainees in 2018. Of the 48% response rate, around 48% admitted hesitancy to continue in their chosen specialty. A further 12% planned to depart from their field after completion of training. Factors associated with discontinuation in training were the perception of ineffective psychotherapeutic treatments and a lack of autonomy at work; which was strongly correlated to the doctor's role and team collaboration. Workload was generally perceived as excessive, with not enough time for after work recovery and the subsequent negative impact on private life. However, these factors were not found to significantly affect trainees' decision to leave. The doctor's role requires better clarification and medical leadership needs to be improved, so that evidence based treatments can be offered.
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Affiliation(s)
- Tobias Blechinger
- NU-sjukvården - BUP Trollhattan, Sweden NU-sjukvården - BUP Trollhattan, Sweden
| | - Sara Lundqvist
- Drottning Silvias barn- och ungdomssjukhus i Goteborg - Goteborg, Sweden Drottning Silvias barn- och ungdomssjukhus i Goteborg - Goteborg, Sweden
| | | | - Maria Unenge Hallerbäck
- Centralsjukhuset i Karlstad - Karlstad, Sweden Barn- och ungdomspsykiatri Karlstad - Karlstad, Sweden
| | - Håkan Jarbin
- Lunds Universitet Institutionen för kliniska vetenskaper i Lund - Lund, Sweden Lunds Universitet Institutionen för kliniska vetenskaper i Lund - Lund, Sweden
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Abstract
INTRODUCTION Therapeutic relationship in forensic psychiatry is believed to be affected by the coercive setting and the role conflict of the therapists as both treaters and court-appointed experts. The aim of the study was to examine and compare the therapeutic relationship in forensic and general psychiatric settings. MATERIAL AND METHODS 52 forensic patients and 66 general psychiatric patients filled in the Psychopathy Personality Inventory - Revised (PPI-R), the Inventory of Interpersonal Problems - German Version (IIP-D), the Questionnaire on Motivation for Psychotherapy (Fragebogen zur Erfassung der Psychotherapiemotivation (FPTM)) as well as the Working Alliance Inventory - Short Revised (WAI-SR). We applied descriptive analyses, calculated univariate t-tests as well as multivariate T-tests and performed general linear models. RESULTS The quality of the therapeutic alliance does not differ significantly between forensic and general psychiatric patients. Moreover, patients of forensic psychiatry consider therapeutic techniques applied by their therapists as more valuable for achieving their therapeutic aims than patients of the general psychiatry. DISCUSSION The therapeutic relationship in forensic psychiatry is as viable as in general psychiatry. This can be regarded as a result of the long-term therapy in the context of forensic psychiatry which allows more time to be spent on relationship building than in a general psychiatry setting where therapy is limited to a few weeks.
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Affiliation(s)
- Stefanie Otte
- Universität Ulm, Klinik für Forensische Psychiatrie und Psychotherapie am BKH Günzburg
| | - Judith Streb
- Universität Ulm, Klinik für Forensische Psychiatrie und Psychotherapie am BKH Günzburg
| | - Katharina Rasche
- Universität Ulm, Klinik für Forensische Psychiatrie und Psychotherapie am BKH Günzburg
| | - Irina Franke
- Universität Ulm, Klinik für Forensische Psychiatrie und Psychotherapie am BKH Günzburg
| | - Stefanie Nigel
- Universität Ulm, Klinik für Forensische Psychiatrie und Psychotherapie am BKH Günzburg
| | - Felix Segmiller
- Universität Ulm, Klinik für Forensische Psychiatrie und Psychotherapie am BKH Günzburg
| | | | - Nenad Vasic
- Klinikum Christophsbad Göppingen, Klinik für Psychiatrie und Psychotherapie
| | - Manuela Dudeck
- Universität Ulm, Klinik für Forensische Psychiatrie und Psychotherapie am BKH Günzburg
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Hogue A, Dauber S, Bobek M, Jensen-Doss A, Henderson CE. Measurement Training and Feedback System for Implementation of family-based services for adolescent substance use: protocol for a cluster randomized trial of two implementation strategies. Implement Sci 2019; 14:25. [PMID: 30866967 PMCID: PMC6416843 DOI: 10.1186/s13012-019-0874-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article describes a study protocol for testing the Measurement Training and Feedback System for Implementation (MTFS-I) and comparing two implementation strategies for MTFS-I delivery. MTFS-I is a web-based treatment quality improvement system designed to increase the delivery of evidence-based interventions for behavioral health problems in routine care settings. This version of MTFS-I focuses on family-based services (FBS) for adolescent substance use. FBS, comprising both family participation in treatment and family therapy technique use, have achieved the strongest evidence base for adolescent substance use and are a prime candidate for upgrading treatment quality in outpatient care. For FBS to fulfill their potential for widespread dissemination, FBS implementation must be bolstered by effective quality procedures that support sustainable delivery in usual care. METHODS/DESIGN Adapted from measurement feedback systems for client outcomes, MTFS-I contains three synergistic components: (a) weekly reporter training modules to instruct therapists in reliable post-session self-reporting on FBS utilization; (b) weekly mock session videos of FBS interventions (5-8 min) for supportive training in, and practice coding of, high-quality FBS; and (c) monthly feedback reports to therapists and supervisors displaying aggregated data on therapist-reported FBS use. MTFS-I is hosted online and requires approximately 20 min per week to complete. The study will experimentally compare two well-established implementation strategies designed to foster ongoing MTFS-I usage: Core Training, consisting of two 3-h training sessions focused on FBS site mapping, selecting FBS improvement goals, and sustaining MTFS-I, followed by routine remote technical assistance; and Core + Facilitation, which boosts Core Training sessions with collaborative phone-based clinical consultation and on-site facilitation meetings for 1 year to promote FBS goal achievement. The study design is a cluster randomized trial testing Core Training versus Core + Facilitation in ten substance use treatment clinics. Study aims will compare conditions on MTFS-I uptake, FBS delivery (based on therapist-report and observational data), and 1-year client outcomes. DISCUSSION Study contributions to implementation science and considerations of MTFS-I sustainability are discussed. TRIAL REGISTRATION ClinicalTrials.gov NCT03342872 . Registered 10 November 2017.
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Affiliation(s)
| | | | | | | | - Craig E. Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX USA
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Schepker R, von Gontard A, von Klitzing K. [Not Available]. Z Kinder Jugendpsychiatr Psychother 2019; 47:172-175. [PMID: 30873915 DOI: 10.1024/1422-4917/a000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Lichtenthal WG, Catarozoli C, Masterson M, Slivjak E, Schofield E, Roberts KE, Neimeyer RA, Wiener L, Prigerson HG, Kissane DW, Li Y, Breitbart W. An open trial of meaning-centered grief therapy: Rationale and preliminary evaluation. Palliat Support Care 2019; 17:2-12. [PMID: 30683164 PMCID: PMC6401220 DOI: 10.1017/s1478951518000925] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the preliminary feasibility, acceptability, and effects of Meaning-Centered Grief Therapy (MCGT) for parents who lost a child to cancer. METHOD Parents who lost a child to cancer and who were between six months and six years after loss and reporting elevated levels of prolonged grief were enrolled in open trials of MCGT, a manualized, one-on-one cognitive-behavioral-existential intervention that used psychoeducation, experiential exercises, and structured discussion to explore themes related to meaning, identity, purpose, and legacy. Parents completed 16 weekly sessions, 60-90 minutes in length, either in person or through videoconferencing. Parents were administered measures of prolonged grief disorder symptoms, meaning in life, and other assessments of psychological adjustment preintervention, mid-intervention, postintervention, and at three months postintervention. Descriptive data from both the in-person and videoconferencing open trial were pooled.ResultEight of 11 (72%) enrolled parents started the MCGT intervention, and six of eight (75%) participants completed all 16 sessions. Participants provided positive feedback about MCGT. Results showed postintervention longitudinal improvements in prolonged grief (d = 1.70), sense of meaning (d = 2.11), depression (d = 0.84), hopelessness (d = 1.01), continuing bonds with their child (d = 1.26), posttraumatic growth (ds = 0.29-1.33), positive affect (d = 0.99), and various health-related quality of life domains (d = 0.46-0.71). Most treatment gains were either maintained or increased at the three-month follow-up assessment.Significance of resultsOverall, preliminary data suggest that this 16-session, manualized cognitive-behavioral-existential intervention is feasible, acceptable, and associated with transdiagnostic improvements in psychological functioning among parents who have lost a child to cancer. Future research should examine MCGT with a larger sample in a randomized controlled trial.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - David W Kissane
- The University of Notre Dame Australia,Fremantle,Western Australia
| | - Yuelin Li
- Memorial Sloan Kettering Cancer Center,New York,NY
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Vargas-de la Cruz I, Pardo-Cebrián R, Martínez Sánchez H, Froján-Parga MX. Rule Emission: A Possible Variable for Improved Therapeutic Practice. Span J Psychol 2018; 21:E38. [PMID: 30355381 DOI: 10.1017/sjp.2018.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
It has been suggested that achieving greater effectiveness in psychotherapeutic treatment requires analyzing what therapists actually do and say, how they do this and when it is done. Based on this approach, in this study we focused on the rules emitted by therapists, since providing rules is thought to be of fundamental importance in promoting effective and efficient clinical change. Specifically, we sought to determine whether the experience level of therapists and the brevity of therapy would be related to patterns of therapist rule emission as categorized by the Category System of Rules emitted by the Therapist (SISC-RULES-T) (Vargas-de la Cruz & Pardo-Cebrián, 2014). Greater therapist experience and shorter therapy duration were found to be reliably predictive of more rule emissions across most rule categories (Z values between: Z = -3.68 and Z = -2.05; p values: p < .05 and p < .001). These variables were also predictive of more emissions of rules that specified all three operant contingency elements (situation, behavior, and consequence) rather than fewer elements (Z = -2.59, p < .05; Z = -2.26, p < .05). In the expert therapists and therapist with shorter cases, there was a nonsignificant tendency for the emission of general and conceptual rules to increase over sessions whereas emissions of concrete and particular rules tended to decrease; the explicitness of the three contingency elements also tended to decrease as treatment progressed. These findings may help to identify verbal characteristics of therapists that could lead to improved therapeutic practice.
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28
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Delamater AM, de Wit M, McDarby V, Malik JA, Hilliard ME, Northam E, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes 2018; 19 Suppl 27:237-249. [PMID: 30058247 DOI: 10.1111/pedi.12736] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 01/09/2023] Open
MESH Headings
- Adaptation, Psychological/physiology
- Adolescent
- Burnout, Psychological/psychology
- Burnout, Psychological/therapy
- Child
- Consensus
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Endocrinology/organization & administration
- Endocrinology/standards
- Humans
- International Cooperation
- Neurodevelopmental Disorders/therapy
- Pediatrics/organization & administration
- Pediatrics/standards
- Practice Patterns, Physicians'/standards
- Psychotherapy/methods
- Psychotherapy/standards
- Quality of Life/psychology
- Resilience, Psychological
- Societies, Medical/organization & administration
- Societies, Medical/standards
- Stress, Psychological/etiology
- Stress, Psychological/therapy
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Affiliation(s)
- Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Maartje de Wit
- Department of Medical Psychology, EMGO Institute for Health & Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Vincent McDarby
- National Children's Research Centre and Our Lady's Children's Hospital, Dublin, Ireland
| | - Jamil A Malik
- Center of Excellence, National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | | | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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Johne J, von Peter S, Schwarz J, Timm J, Heinze M, Ignatyev Y. Evaluation of new flexible and integrative psychiatric treatment models in Germany- assessment and preliminary validation of specific program components. BMC Psychiatry 2018; 18:278. [PMID: 30176836 PMCID: PMC6122621 DOI: 10.1186/s12888-018-1861-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flexible and integrative treatment (FIT) models are rather novel in German mental health care. This study aimed at identifying and evaluating empirically based, practicable, and quantifiable program components that describe the specific treatment structures and processes of German FIT models. METHODS A multi-step, iterative research process, based on Grounded Theory Methodology (GTM), was used to identify and operationalise components. A complex algorithm and expert-interviews were applied to quantify the relative weight of each component and to develop a sum score. Face and content validity were examined and internal consistency was tested by Cronbach's α coefficient. RESULTS Ten of eleven FIT components could be operationalised, quantified and united in the total score. All operationalised components showed sufficient face and content validity and eight components had a good reliability. CONCLUSIONS The components are a first step in the process of operationally defining German FIT models. They considerably overlap with various critical ingredients of international FIT models and may serve as a theoretical basis for constructing fidelity tools and research guides to enable process and outcome evaluation of German FIT models.
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Affiliation(s)
- Jakob Johne
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sebastian von Peter
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Julian Schwarz
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Jürgen Timm
- Biometry Section, Competence Center for Clinical Trials, University of Bremen, Bremen, Germany
| | - Martin Heinze
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Yuriy Ignatyev
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
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Duff W, Haskey N, Potter G, Alcorn J, Hunter P, Fowler S. Non-pharmacological therapies for inflammatory bowel disease: Recommendations for self-care and physician guidance. World J Gastroenterol 2018; 24:3055-3070. [PMID: 30065553 PMCID: PMC6064965 DOI: 10.3748/wjg.v24.i28.3055] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/23/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023] Open
Abstract
We performed a scoping review on sought-after complementary therapies for patients with inflammatory bowel disease (IBD), specifically diet, physical activity and exercise (PA/E), and psychotherapy. We aim to update patients with IBD on therapies for self-care and provide physicians with guidance on how to direct their patients for the management of IBD. A search of MEDLINE, EMBASE, and PUBMED was completed in Sept 2016. Studies on diet, PA/E, or psychotherapy in patients with IBD were included. Medical Subject Heading terms and Boolean operators were used. The search was limited to full-text English articles describing an adult population. This review included 67 studies: Diet (n = 19); PA/E (n = 19); and psychotherapy (n = 29). We have made the following recommendations: (1) Diet: Consumption of diets rich in vegetables, fruit and soluble fiber may be beneficial in IBD. A trial of a low FODMAP diet can be considered in those patients with functional gastrointestinal symptoms. Restrictive diets are lacking in evidence and should be avoided; (2) PA/E: Regular low-moderate intensity activity, including cardiovascular and resistance exercise, has been shown to improve quality of life (QOL) and may improve inflammation; and (3) psychotherapy: Therapies such as cognitive-behavioural interventions, mindfulness, hypnosis, and stress management have been shown to improve QOL, but evidence is limited on their impact on anxiety, depression, and disease activity. Overall, these complementary therapies are promising and should be used to treat patients with IBD from a more holistic perspective.
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Affiliation(s)
- Whitney Duff
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B2, Canada
| | - Natasha Haskey
- Irving K Barber School of Arts and Science, University of British Columbia-Okanagan, Kelowna, British Columbia V1V 1V7, Canada
| | - Gillian Potter
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5A5, Canada
| | - Jane Alcorn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Paulette Hunter
- St Thomas More College, University of Saskatchewan, Saskatoon, SK S7N 0W6, Canada
| | - Sharyle Fowler
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 0W8, Canada
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Pinto-Coelho KG, Hill CE, Kearney MS, Sarno EL, Sauber ES, Baker SM, Brady J, Ireland GW, Hoffman MA, Spangler PT, Thompson BJ. When in doubt, sit quietly: A qualitative investigation of experienced therapists' perceptions of self-disclosure. J Couns Psychol 2018; 65:440-452. [PMID: 29999370 DOI: 10.1037/cou0000288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Using consensual qualitative research (CQR), we analyzed 13 interviews of experienced psychotherapists about general intentions for therapist self-disclosure (TSD), experiences with successful TSDs, experiences with unsuccessful TSDs, and instances of unmanifested urges to disclose. For TSD generally (i.e., not about a specific instance), typical intentions were to facilitate exploration and build and maintain the therapeutic relationship. Therapists typically reported becoming more comfortable using TSD over time. In successful TSDs, the typical content was accurate, relevant similarities between therapist and client; typical consequences were positive. In unsuccessful TSDs, the typical antecedent was countertransference reactions; the typical intention was to provide support; typical content involved therapists mistakenly perceiving similarities with clients; and the general consequences were negative. In instances when therapists repressed the urge to disclose, the typical antecedent was countertransference and the content typically seemed relevant to the client's issues. We conclude that effective use of TSD requires general attunement to the client's dynamics, attunement to the client's readiness in the moment, ability to manage countertransference, and ability to use a specific TSD appropriately. Implications for practice, training, and research are discussed. (PsycINFO Database Record
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Affiliation(s)
| | - Clara E Hill
- Department of Psychology, University of Maryland, College Park
| | | | - Elissa L Sarno
- Department of Psychology, University of Maryland, College Park
| | | | - Sydney M Baker
- Department of Psychology, University of Maryland, College Park
| | - Jennifer Brady
- Department of Psychology, University of Maryland, College Park
| | - Glenn W Ireland
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park
| | - Mary Ann Hoffman
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park
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van de Water T, Rossouw J, Yadin E, Seedat S. Adolescent and nurse perspectives of psychotherapeutic interventions for PTSD delivered through task-shifting in a low resource setting. PLoS One 2018; 13:e0199816. [PMID: 29990372 PMCID: PMC6038985 DOI: 10.1371/journal.pone.0199816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/14/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This investigation compared the perceived effectiveness of supportive counselling (SC) and prolonged exposure for adolescents (PE-A) by treatment users (adolescents with PTSD) and non-specialist treatment providers (supervised nurses). METHOD Adolescent participants and nurse providers were purposively recruited to share their experiences of trial participation through face to face semi-structured in-depth interviews and treatment-specific focus groups (all recorded). Twelve adolescent participant transcripts (ten interviews and two focus groups) and three nurse provider transcripts were doubly transcribed. Thematic content analysis was applied using Atlas.ti software. Two emerging themes are presented in this paper: 1) Perceptions of the intervention and 2) Usefulness of the intervention. RESULTS Regardless of treatment arm, adolescents experienced warm counselling relationships and described the process of extending trust to the counselor. Adolescents in the PE-A arm provided clear descriptions of session structure and treatment rationale compared with adolescents receiving SC. The most helpful tools were breathing retraining and imaginal exposure for PE-A and creation of distraction strategies during non-directive SC. Adolescents in both arms continued to use the techniques acquired during treatment and reported symptom improvement. Participants who received SC acknowledged ongoing reexperiencing. Nurses perceived SC to be an immediately transferable skill, but feedback on their preference for one intervention over the other was inconclusive. CONCLUSION Both PTSD treatment strategies, implemented by non-specialists, were perceived as helpful. Overall, adolescents reported warm therapeutic relationships and a reduction in PTSD symptoms. Nurses stated that they would require institutional support to ensure delivery of these interventions in a scalable and sustainable manner.
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Affiliation(s)
- Tanya van de Water
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Jaco Rossouw
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, Pennsylvania, United States of America
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Abstract
A growing body of literature attests to the existence of therapist effects with little explanation of this phenomenon. This study therefore investigated the role of resilience and mindfulness as factors related to practitioner wellbeing and associated effective practice. Data comprised practitioners (n = 37) and their patient outcome data (n = 4980) conducted within a stepped care model of service delivery. Analyses employed benchmarking and multilevel modeling to identify more and less effective practitioners via yoking of therapist factors and nested patient outcomes. A therapist effect of 6.7 % was identified based on patient depression (PHQ-9) outcome scores. More effective practitioners compared to less effective practitioners displayed significantly higher levels of mindfulness as well as resilience and mindfulness combined. Implications for policy, research and practice are discussed.
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Affiliation(s)
- Jo-Ann Pereira
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Michael Barkham
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Stephen Kellett
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield; Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - David Saxon
- Centre for Psychological Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Wiltsey Stirman S, Marques L, Creed TA, Gutner CA, DeRubeis R, Barnett PG, Kuhn E, Suvak M, Owen J, Vogt D, Jo B, Schoenwald S, Johnson C, Mallard K, Beristianos M, La Bash H. Leveraging routine clinical materials and mobile technology to assess CBT fidelity: the Innovative Methods to Assess Psychotherapy Practices (imAPP) study. Implement Sci 2018; 13:69. [PMID: 29789017 PMCID: PMC5964900 DOI: 10.1186/s13012-018-0756-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/19/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Identifying scalable strategies for assessing fidelity is a key challenge in implementation science. However, for psychosocial interventions, the existing, reliable ways to test treatment fidelity quality are often labor intensive, and less burdensome strategies may not reflect actual clinical practice. Cognitive behavioral therapies (CBTs) provide clinicians with a set of effective core elements to help treat a multitude of disorders, which, evidence suggests, need to be delivered with fidelity to maximize potential client impact. The current "gold standard" for rating CBTs is rating recordings of therapy sessions, which is extremely time-consuming and requires a substantial amount of initial training. Although CBTs can vary based on the target disorder, one common element employed in most CBTs is the use of worksheets to identify specific behaviors and thoughts that affect a client's ability to recover. The present study will develop and evaluate an innovative new approach to rate CBT fidelity, by developing a universal CBT scoring system based on worksheets completed in therapy sessions. METHODS To develop a scoring system for CBT worksheets, we will compile common CBT elements from a variety of CBT worksheets for a range of psychiatric disorders and create adherence and competence measures. We will collect archival worksheets from past studies to test the scoring system and assess test-retest reliability. To evaluate whether CBT worksheet scoring accurately reflects clinician fidelity, we will recruit clinicians who are engaged in a CBT for depression, anxiety, and/or posttraumatic stress disorder. Clinicians and clients will transmit routine therapy materials produced in session (e.g., worksheets, clinical notes, session recordings) to the study team after each session. We will compare observer-rated fidelity, clinical notes, and fidelity-rated worksheets to identify the most effective and efficient method to assess clinician fidelity. Clients will also be randomly assigned to either complete the CBT worksheets on paper forms or on a mobile application (app) to learn if worksheet format influences clinician and client experience or differs in terms of reflecting fidelity. DISCUSSION Scoring fidelity using CBT worksheets may allow clinics to test fidelity in a short and effective manner, enhancing continuous quality improvement in the workplace. Clinicians and clinics can use such data to improve clinician fidelity in real time, leading to improved patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03479398 . Retrospectively registered March 20, 2018.
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Affiliation(s)
- Shannon Wiltsey Stirman
- National Center for PTSD, VA Palo Alto HCS and Stanford University Department of Psychiatry and Behavioral Sciences, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Luana Marques
- Harvard Medical School and Massachusetts General Hospital, 70 Everett Ave., Chelsea, MA 02150 USA
| | - Torrey A. Creed
- University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3038, Philadelphia, PA 19104 USA
| | - Cassidy A. Gutner
- National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine, 150 S. Huntington Ave., Boston, MA 02130 USA
| | - Robert DeRubeis
- School of Arts and Sciences, University of Pennsylvania, 425 S. University Ave., Philadelphia, PA 19104 USA
| | - Paul G. Barnett
- Palo Alto Veterans Institute for Research, 3801 Miranda Ave., Palo Alto, CA 94304 USA
| | - Eric Kuhn
- National Center for PTSD, VA Palo Alto HCS and Stanford University Department of Psychiatry and Behavioral Sciences, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Michael Suvak
- Suffolk University, 73 Tremont Street, Boston, MA 02108 USA
| | - Jason Owen
- National Center for PTSD, VA Palo Alto HCS and Stanford University Department of Psychiatry and Behavioral Sciences, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Dawne Vogt
- National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine, 150 S. Huntington Ave., Boston, MA 02130 USA
| | - Booil Jo
- Stanford University, 401 Quarry Rd, Stanford, CA 94305 USA
| | | | - Clara Johnson
- National Center for PTSD, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Kera Mallard
- National Center for PTSD, 795 Willow Road, Menlo Park, CA 94025 USA
| | | | - Heidi La Bash
- National Center for PTSD, 795 Willow Road, Menlo Park, CA 94025 USA
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Ankarberg P. [Not Available]. Lakartidningen 2018; 115:E6FA. [PMID: 29714808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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36
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Högberg G. [Not Available]. Lakartidningen 2018; 115:EZS7. [PMID: 29461572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Bernanke J, McCommon B. Training in Good Psychiatric Management for Borderline Personality Disorder in Residency: An Aide to Learning Supportive Psychotherapy for Challenging-to-Treat Patients. Psychodyn Psychiatry 2018; 46:181-200. [PMID: 29809114 DOI: 10.1521/pdps.2018.46.2.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Given many competing demands, psychotherapy training to competency is difficult during psychiatric residency. Good Psychiatric Management for borderline personality disorder (GPM) offers an evidence-based, simplified, psychodynamically informed framework for the outpatient management of patients with borderline personality disorder, one of the most challenging disorders psychiatric residents must learn to treat. In this article, we provide an overview of GPM, and show that training in GPM meets a requirement for training in supportive psychotherapy; builds on psychodynamic psychotherapy training; and applies to other severe personality disorders, especially narcissistic personality disorder. We describe the interpersonal hypersensitivity model used in GPM as a straightforward way for clinicians to collaborate with patients in organizing approaches to psychoeducation, treatment goals, case management, use of multiple treatment modalities, and safety. A modification of the interpersonal hypersensitivity model that includes intra-personal hypersensitivity can be used to address narcissistic problems often present in borderline personality disorder. We argue that these features make GPM ideally suited for psychiatry residents in treating their most challenging patients, provide clinical examples to illustrate these points, and report the key lessons learned by a psychiatry resident after a year of GPM supervision.
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Affiliation(s)
- Joel Bernanke
- Department of Psychiatry, Columbia University
- New York State Psychiatric Institute
| | - Benjamin McCommon
- Department of Psychiatry, Columbia University
- New York State Psychiatric Institute
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Affiliation(s)
- R Noack
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - K Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland
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Abstract
There is a need for empirical outcome research in psychodynamic and psychoanalytic therapy. However, both the approach of empirically supported therapies (EST) and the procedures of evidence-based medicine (EBM) have severe limitations making randomised controlled trials (RCTs) an absolute standard. After a critical discussion of this approach, the author reviews the empirical evidence for the efficacy of psychodynamic psychotherapy in specific psychiatric disorders. The review aims to identify for which psychiatric disorders RCTs of specific models of psychodynamic psychotherapy are available and for which they are lacking, thus providing a basis for planning further research. In addition, results of process research of psychodynamic psychotherapy are presented. As the methodology of RCTs is not appropriate for psychoanalytic therapy, effectiveness studies of psychoanalytic therapy are reviewed as well. Studies of psychodynamic psychotherapy published between 1960 and 2004 were identified by a computerised search using Medline, PsycINFO and Current Contents. In addition, textbooks and journal articles were used. Twenty-two RCTs were identified of which 64% had not been included in the 1998 report by Chambless and Hollon. According to the results, for the following psychiatric disorders at least one RCT providing evidence for the efficacy of psychodynamic psychotherapy was identified: depressive disorders (4 RCTs), anxiety disorders (1 RCT), post-traumatic stress disorder (1 RCT), somatoform disorder (4 RCTs), bulimia nervosa (3 RCTs), anorexia nervosa (2 RCTs), borderline personality disorder (2 RCTs), Cluster C personality disorder (1 RCT), and substance-related disorders (4 RCTs). According to results of process research, outcome in psychodynamic psychotherapy is related to the competent delivery of therapeutic techniques and to the development of a therapeutic alliance. With regard to psychoanalytic therapy, controlled quasi-experimental effectiveness studies provide evidence that psychoanalytic therapy is (1) more effective than no treatment or treatment as usual, and (2) more effective than shorter forms of psychodynamic therapy. Conclusions are drawn for future research.
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Affiliation(s)
- Falk Leichsenring
- Clinic of Tiefenbrunn and University of Gottingen, von Sieboldstr 5, D-37075, Gottingen, Germany.
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Levitt HM, Pomerville A, Surace FI, Grabowski LM. Metamethod study of qualitative psychotherapy research on clients' experiences: Review and recommendations. J Couns Psychol 2017; 64:626-644. [PMID: 29154575 DOI: 10.1037/cou0000222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A metamethod study is a qualitative meta-analysis focused upon the methods and procedures used in a given research domain. These studies are rare in psychological research. They permit both the documentation of the informal standards within a field of research and recommendations for future work in that area. This paper presents a metamethod analysis of a substantial body of qualitative research that focused on clients' experiences in psychotherapy (109 studies). This review examined the ways that methodological integrity has been established across qualitative research methods. It identified the numbers of participants recruited and the form of data collection used (e.g., semistructured interviews, diaries). As well, it examined the types of checks employed to increase methodological integrity, such as participant counts, saturation, reflexivity techniques, participant feedback, or consensus and auditing processes. Central findings indicated that the researchers quite flexibly integrated procedures associated with one method into studies using other methods in order to strengthen their rigor. It appeared normative to adjust procedures to advance methodological integrity. These findings encourage manuscript reviewers to assess the function of procedures within a study rather than to require researchers to adhere to the set of procedures associated with a method. In addition, when epistemological approaches were mentioned they were overwhelmingly constructivist in nature, despite the increasing use of procedures traditionally associated with objectivist perspectives. It is recommended that future researchers do more to explicitly describe the functions of their procedures so that they are coherently situated within the epistemological approaches in use. (PsycINFO Database Record
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Affiliation(s)
- Heidi M Levitt
- Department of Psychology, University of Massachusetts Boston
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Affiliation(s)
- Falk Leichsenring
- University of Giessen, Department of Psychosomatics and Psychotherapy, Giessen, Germany
| | - Christiane Steinert
- University of Giessen, Department of Psychosomatics and Psychotherapy, Giessen, Germany
- MSB Medical School Berlin, Department of Psychology, Berlin, Germany
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Abstract
Postpartum depression is a debilitating disorder that requires greater awareness and treatment. Depending on severity of symptoms, standard treatment calls for individual psychotherapy and medication. Although postpartum depression can lead to negative health outcomes for women and their offspring, numerous barriers prevent women from receiving appropriate care. A review of the literature shows that nontraditional modes of psychotherapy dominate recent studies, whereas data for other complementary options are severely lacking. Further research is needed to help identify cost-effective alternative therapies for treating postpartum depression. Combined with prevention and screening, treatment options that suit women's varied situations and preferences must be explored to increase reception and adherence to treatment and, ultimately, to improve outcomes.
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Abstract
As the fields of counseling and psychotherapy have become more cognizant that individuals, couples, and families bring with them a myriad of diversity factors into therapy, multicultural competency has also become a crucial component in the development of clinicians during clinical supervision and training. We employed a qualitative meta-analysis to provide a detailed and comprehensive description of similar themes identified in primary qualitative studies that have investigated supervisory practices with an emphasis on diversity. Findings revealed six meta-categories, namely: (a) Supervisor's Multicultural Stances; (b) Supervisee's Multicultural Encounters; (c) Competency-Based Content in Supervision; (d) Processes Surrounding Multicultural Supervision; (e) Culturally Attuned Interventions; and (f) Multicultural Supervisory Alliance. Implications for practice are discussed.
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Abstract
The idea of trans-diagnostic and modular treatments highlighted in this Editorial points the way beyond self-contained 'branded' therapies to a more flexible intervention science responsive to advances in basic science and relevant also to personalisation of therapies. For such approaches to be rigorous, there need to be empirically identified trans-diagnostic target mechanisms. The Editorial reviews two studies of potential mechanisms of this kind in the developmental neurobiology of stress response in children at risk from prenatal maternal stress and post natal neglect and maltreatment. A number of treatment trials are also reviewed illustrating the common method of digitally-aided therapy; a common theme is the difficult in sustaining adherence to such treatment delivery methods. Finally it reviews a useful independent investigation of a commonly used autism screening instrument, suggesting improvements for greater specificity.
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Bryant RA, Schafer A, Dawson KS, Anjuri D, Mulili C, Ndogoni L, Koyiet P, Sijbrandij M, Ulate J, Harper Shehadeh M, Hadzi-Pavlovic D, van Ommeren M. Effectiveness of a brief behavioural intervention on psychological distress among women with a history of gender-based violence in urban Kenya: A randomised clinical trial. PLoS Med 2017; 14:e1002371. [PMID: 28809935 PMCID: PMC5557357 DOI: 10.1371/journal.pmed.1002371] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/10/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Gender-based violence (GBV) represents a major cause of psychological morbidity worldwide, and particularly in low- and middle-income countries (LMICs). Although there are effective treatments for common mental disorders associated with GBV, they typically require lengthy treatment programs that may limit scaling up in LMICs. The aim of this study was to test the effectiveness of a new 5-session behavioural treatment called Problem Management Plus (PM+) that lay community workers can be taught to deliver. METHODS AND FINDINGS In this single-blind, parallel, randomised controlled trial, adult women who had experienced GBV were identified through community screening for psychological distress and impaired functioning in Nairobi, Kenya. Participants were randomly allocated in a 1:1 ratio either to PM+ delivered in the community by lay community health workers provided with 8 days of training or to facility-based enhanced usual care (EUC) provided by community nurses. Participants were aware of treatment allocation, but research assessors were blinded. The primary outcome was psychological distress as measured by the total score on the 12-item General Health Questionnaire (GHQ-12) assessed at 3 months after treatment. Secondary outcomes were impaired functioning (measured by the WHO Disability Adjustment Schedule [WHODAS]), symptoms of posttraumatic stress (measured by the Posttraumatic Stress Disorder Checklist [PCL]), personally identified problems (measured by Psychological Outcome Profiles [PSYCHLOPS]), stressful life events (measured by the Life Events Checklist [LEC]), and health service utilisation. Between 15 April 2015 and 20 August 2015, 1,393 women were screened for eligibility on the basis of psychological distress and impaired functioning. Of these, 518 women (37%) screened positive, of whom 421 (81%) were women who had experienced GBV. Of these 421 women, 209 were assigned to PM+ and 212 to EUC. Follow-up assessments were completed on 16 January 2016. The primary analysis was intention to treat and included 53 women in PM+ (25%) and 49 women in EUC (23%) lost to follow-up. The difference between PM+ and EUC in the change from baseline to 3 months on the GHQ-12 was 3.33 (95% CI 1.86-4.79, P = 0.001) in favour of PM+. In terms of secondary outcomes, for WHODAS the difference between PM+ and EUC in the change from baseline to 3-month follow-up was 1.96 (95% CI 0.21-3.71, P = 0.03), for PCL it was 3.95 (95% CI 0.06-7.83, P = 0.05), and for PSYCHLOPS it was 2.15 (95% CI 0.98-3.32, P = 0.001), all in favour of PM+. These estimated differences correspond to moderate effect sizes in favour of PM+ for GHQ-12 score (0.57, 95% CI 0.32-0.83) and PSYCHLOPS (0.67, 95% CI 0.31-1.03), and small effect sizes for WHODAS (0.26, 95% CI 0.02-0.50) and PCL (0.21, 95% CI 0.00-0.41). Twelve adverse events were reported, all of which were suicidal risks detected during screening. No adverse events were attributable to the interventions or the trial. Limitations of the study include no long-term follow-up, reliance on self-report rather than structured interview data, and lack of an attention control condition. CONCLUSIONS Among a community sample of women in urban Kenya with a history of GBV, a brief, lay-administered behavioural intervention, compared with EUC, resulted in moderate reductions in psychological distress at 3-month follow-up. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614001291673.
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Affiliation(s)
- Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- * E-mail:
| | - Alison Schafer
- World Vision International, Monrovia, California, United States of America
| | - Katie S. Dawson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | - Melissa Harper Shehadeh
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Dusan Hadzi-Pavlovic
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Charalampopoulos D, Hesketh KR, Amin R, Paes VM, Viner RM, Stephenson T. Psycho-educational interventions for children and young people with Type 1 Diabetes in the UK: How effective are they? A systematic review and meta-analysis. PLoS One 2017; 12:e0179685. [PMID: 28665946 PMCID: PMC5493302 DOI: 10.1371/journal.pone.0179685] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/02/2017] [Indexed: 11/29/2022] Open
Abstract
Aims To synthesise evidence from UK-based randomised trials of psycho-educational interventions in children and young people (CYP) with Type 1 Diabetes (T1D) to inform the evidence-base for adoption of such interventions into the NHS. Methods We searched Medline, Embase, Cochrane, PsycINFO, CINAHL, and Web of Science up to March 2016. Two reviewers independently selected UK-based randomised trials comparing psycho-educational interventions for improving management of T1D for CYP with a control group of usual care or attention control. The main outcome was glycaemic control measured by percentage of glycated haemoglobin (HbA1c); secondary outcomes included psychosocial functioning, diabetes knowledge, adverse and other clinical outcomes. A narrative synthesis and meta-analysis were conducted. Pooled effect sizes of standardised mean difference (SMD) were calculated. Results Ten eligible trials of three educational and seven psycho-educational interventions were identified. Most interventions were delivered by non-psychologists and targeted adolescents with more than one year duration of diabetes. Meta-analysis of nine of these trials (N = 1,838 participants) showed a non-significant reduction in HbA1c attributable to the intervention (pooled SMD = -0.06, 95% CI: -0.21 to 0.09). Psycho-educational interventions aiming to increase children’s self-efficacy had a moderate, beneficial effect (SMD = 0.50, 95% CI: 0.13 to 0.87). No benefits on diabetes knowledge and other indicators of psychosocial functioning were identified. Conclusions There is insufficient evidence to recommend the use of particular psycho-educational programme for CYP with T1D in the UK. Further trials with sufficient power and reporting standards are needed. Future trials could consider active involvement of psychological specialists in the delivery of psychologically informed interventions and implementation of psycho-educational interventions earlier in the course of the disease. Systematic review registration PROSPERO CRD42015010701
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Affiliation(s)
- Dimitrios Charalampopoulos
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- * E-mail:
| | - Kathryn R. Hesketh
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Rakesh Amin
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Veena Mazarello Paes
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Russell M. Viner
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Terence Stephenson
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Leichsenring F, Abbass A, Hilsenroth MJ, Leweke F, Luyten P, Keefe JR, Midgley N, Rabung S, Salzer S, Steinert C. Biases in research: risk factors for non-replicability in psychotherapy and pharmacotherapy research. Psychol Med 2017; 47:1000-1011. [PMID: 27955715 DOI: 10.1017/s003329171600324x] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Replicability of findings is an essential prerequisite of research. For both basic and clinical research, however, low replicability of findings has recently been reported. Replicability may be affected by research biases not sufficiently controlled for by the existing research standards. Several biases such as researcher allegiance or selective reporting are well-known for affecting results. For psychotherapy and pharmacotherapy research, specific additional biases may affect outcome (e.g. therapist allegiance, therapist effects or impairments in treatment implementation). For meta-analyses further specific biases are relevant. In psychotherapy and pharmacotherapy research these biases have not yet been systematically discussed in the context of replicability. Using a list of 13 biases as a starting point, we discuss each bias's impact on replicability. We illustrate each bias by selective findings of recent research, showing that (1) several biases are not yet sufficiently controlled for by the presently applied research standards, (2) these biases have a pernicious effect on replicability of findings. For the sake of research credibility, it is critical to avoid these biases in future research. To control for biases and to improve replicability, we propose to systematically implement several measures in psychotherapy and pharmacotherapy research, such as adversarial collaboration (inviting academic rivals to collaborate), reviewing study design prior to knowing the results, triple-blind data analysis (including subjects, investigators and data managers/statisticians), data analysis by other research teams (crowdsourcing), and, last not least, updating reporting standards such as CONSORT or the Template for Intervention Description and Replication (TIDieR).
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Affiliation(s)
- F Leichsenring
- Department of Psychosomatics and Psychotherapy,Justus-Liebig-University Giessen,Giessen,Germany
| | - A Abbass
- Department of Psychiatry,Dalhousie University,Centre for Emotions and Health,Halifax,NS,Canada
| | - M J Hilsenroth
- The Derner Institute of Advanced Psychological Studies,Adelphi University,NY,USA
| | - F Leweke
- Department of Psychosomatics and Psychotherapy,Justus-Liebig-University Giessen,Giessen,Germany
| | - P Luyten
- Faculty of Psychology and Educational Sciences,University of Leuven,Klinische Psychologie (OE),Leuven,Belgium
| | - J R Keefe
- Department of Psychology,University of Pennsylvania,Philadelphia,PA,USA
| | | | - S Rabung
- Department of Psychology,Alpen-Adria-Universität Klagenfurt,Universitätsstr,Klagenfurt,Austria
| | - S Salzer
- Clinic of Psychosomatic Medicine and Psychotherapy,Georg-August-Universität Goettingen,Göttingen,Germany
| | - C Steinert
- Department of Psychosomatics and Psychotherapy,Justus-Liebig-University Giessen,Giessen,Germany
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48
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Ankarberg P. [Let reality affect the evidence]. Lakartidningen 2017; 114:EI6U. [PMID: 28323313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Griffith R. Authorisation for deprivation of liberty when receiving treatment for a mental disorder in hospital. Br J Nurs 2017; 26:182-183. [PMID: 28185484 DOI: 10.12968/bjon.2017.26.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Richard Griffith
- Senior Lecturer in Health Law at Swansea University, discusses when an informal patient would be eligible to be deprived of their liberty under the deprivation of liberty safeguards
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50
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Smit A, Kemps A, Zoun M, Spijker J. [Adequacy of treatment for chronic anxiety or depression; an exploratory study of treatment practice]. Tijdschr Psychiatr 2017; 59:422-426. [PMID: 28703262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Many patients with anxiety or depression receiving specialised outpatient treatment at mental health centres do not fully recover. Relapse and chronic course are common. This raises questions about the adequacy of the treatment they receive.<br/> AIM: To obtain insight into the type and length of the treatment given to patients with chronic anxiety or depression.<br/> METHOD: We collected data as part of a national study involving 12 mental health trusts. To be included in the study, patients had to satisfy certain criteria: they had to have received specialised treatment for anxiety or depression for at least two years and there had to be concerns whether these patients would benefit from further treatment in this setting. We gathered information about patient characteristics, diagnosis and treatment history.<br/> RESULTS: On the basis of our selection criteria, 268 patients participated in our study; 65% of the patients were female. Patients were grouped in three categories: 67% were suffering from major depression, 25% from anxiety disorder and 8% from comorbid anxiety and depression. On average, patients had been treated for six years. More than one third of patients had received poor-quality treatment: treatment in the form of psychotherapy and/or pharmacotherapy had not been carried out in accordance with treatment guidelines.<br/> CONCLUSION: In practice, much current treatment falls short of expectations. In particular, pharmacotherapy for depression needs to be improved. Longer periods of treatment should be evaluated at least once every six months.
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