Why are we here at the clinic? Parent–child (dis)agreement on referral problems at outpatient treatment entry.

Do clinic-referred children and their parents agree on the problems for which treatment is undertaken? The authors asked 381 outpatient-clinic-referred children and their parents to list, independently, the child's target problems. Of the parent-child pairs, 63 % failed to agree on even a single problem. When problems were grouped into broad categories (e.g., delinquent, withdrawn), more than a third of the pairs still failed to agree on a single broad problem area. Parent-child agreement was higher for externalizing than for internalizing problem categories (though poor for both). Low parent-child agreement may help explain the poor outcomes often reported for clinic-based child therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized controlled trial of a cognitive–behavioral motivational intervention in a group versus individual format for substance use disorders.

Although group therapy is widely used for individuals with substance use disorders (SUDs), randomized clinical trials (RCTs) comparing the same treatment in a group versus individual format are rare. This paper presents the results of a RCT comparing guided self-change (GSC) treatment, a cognitive–behavioral motivational intervention, conducted in a group versus individual format with 212 alcohol abusers and 52 drug abusers who voluntarily sought outpatient treatment. Treatment outcomes demonstrated significant and large reductions in clients’ alcohol and drug use during treatment and at the 12-month follow-up, with no significant differences between the group and individual therapy conditions. A therapist time ratio analysis found that it took 41.4% less therapist time to treat clients using the group versus the individual format. Participants’ end-of-treatment group cohesion scores characterized the groups as having high engagement, low levels of interpersonal conflict, and low avoidance of group work, all desirable group characteristics. These findings suggest that the GSC treatment model was effectively integrated into a brief group treatment format. Health care cost containment compels further evaluations of the efficacy of group treatments for SUDs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediators of outcome of psychosocial treatments for cocaine dependence.

This study examined endorsement of 12-step philosophy and engagement in recommended 12-step activities as a mediator of the outcomes of individual plus group counseling for cocaine dependence. Assessments of drug use outcomes and the mediator were made at baseline and monthly for 6 months. Engagement in recommended 12-step activities was found to be a partial statistical mediator of drug use outcomes of individual (plus group) drug counseling, but no evidence for change in the mediator preceding change in drug use was found. In addition, a measure of beliefs about addiction developed to test mediation of outcome of cognitive therapy was found to correlate moderately with drug use outcomes in both cognitive therapy and individual drug counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Indicators of Client Engagement: Influences on Alcohol Treatment Satisfaction and Outcomes.

This investigation explored the relationship of client engagement variables (client expectations, therapeutic/working alliance, and session attendance) with treatment satisfaction and posttreatment drinking-related outcomes using data from 2 outpatient alcohol treatment studies (N = 208). Path analysis was used to test a model in which engagement variables jointly influence client satisfaction with treatment and subsequent drinking-related outcomes. The proposed model fit well with the data and accounted for 14-23% of the variance in posttreatment outcomes. The relationships in the model suggest that the link between treatment satisfaction and outcome is clarified by examining client engagement variables, which relate indirectly to outcome by means of client satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of group climate on outcome in two forms of short-term group therapy.

The authors investigated the association between dimensions of perceived group climate (engagement, avoidance, and conflict) and treatment outcome in 2 forms of short-term group psychotherapy. They were particularly interested in the relationship between early group climate and outcome. They also examined whether average group climate and change in group climate were associated with outcome. Both engagement after Session 4 and engagement averaged over the course of therapy were directly associated with improvement. Significant interactions among the group climate dimensions were also found. These findings support the contention that aspects of the group environment influence patient benefit from psychotherapy groups. Possible explanations and implications of the findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How does tele-mental health affect group therapy process? Secondary analysis of a noninferiority trial.

Objective: Video teleconferencing (VTC) is used for mental health treatment delivery to geographically remote, underserved populations. However, few studies have examined how VTC affects individual or group psychotherapy processes. This study compares process variables such as therapeutic alliance and attrition among participants receiving anger management group therapy either through traditional face-to-face delivery or by VTC. Method: The current study represents secondary analyses of a randomized noninferiority trial (Morland et al., in press) in which clinical effectiveness of VTC delivery proved noninferior to in-person delivery. Participants were male veterans (N = 112) with posttraumatic stress disorder (PTSD) and moderate to severe anger problems. The present study examined potential differences in process variables, including therapeutic alliance, satisfaction, treatment credibility, attendance, homework completion, and attrition. Results: No significant differences were found between the two modalities on most process variables. However, individuals in the VTC condition exhibited lower alliance with the group leader than those in the in-person condition. Mean self–leader alliance scores were 4.2 (SD = 0.8) and 4.5 (SD = 0.4), respectively, where 5 represents strongly agree and 4 represents agree with positive statements about the relationship, suggesting that participants in both conditions felt reasonably strong alliance in absolute terms. Individuals who had stronger alliance tended to have better anger outcomes, yet the effect was not strong enough to result in the VTC condition producing inferior aggregate outcomes. Conclusion: Our findings suggest that even if group psychotherapy via VTC differs in subtle ways from in-person delivery, VTC is a viable and effective means of delivering psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic compared with abstinence outcomes of day treatment and contingency management among cocaine-dependent homeless persons.

Substance use disorder diagnoses were used as a treatment outcome measure in a randomized comparison of day treatment (DT) and day treatment plus contingency management (DT+) among homeless persons with primarily crack/cocaine disorders. Participants (N = 127, DT+ = 69, DT = 58, 73.2% male, 82.7% African American) were assessed at baseline and 6-month treatment completion. Binary positive and negative diagnostic outcomes for cocaine, marijuana, and alcohol were compared by treatment group. DT+ was 2.1 times more likely to have a positive treatment outcome than DT. Concordance between diagnostic change and point and continuous abstinence outcomes were found. The use of diagnostic change can be a practical addition to drug toxicology and self-report treatment outcome measures for research and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications of family and peer relations for treatment engagement and follow-up outcomes: An integrative model.

An integrative analytic model was proposed to explain deviance in terms of the family of origin, perceived peer and family relations, psychosocial functioning, motivation for treatment, and treatment engagement. The model was tested by using data from opioid-addicted persons who completed methadone treatment and were interviewed 1 year after discharge. The hypothesized model was shown to fit the data for outcomes at follow-up. A history of poor family relations was related to perceived family dysfunction and peer deviance at treatment entry; these 2 factors in turn predicted poor psychosocial functioning, which was related to higher levels of motivation. Higher motivation was associated with greater treatment engagement, which was associated with reduced opioid use and criminality. The importance of examining associations between family and peer relations and posttreatment outcomes within the context of treatment engagement is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Co-therapists and the creation of a functional psychotherapy group: A group dynamics perspective.

This article supports Dugo and Beck's (1997) proposal that co-therapy teams should move through the early phases of their own development as a team before meeting with a therapy group. Effective leaders facilitate group development by meeting the needs of the group at various stages. To do this, co-therapists must agree on the nature of those needs. Co-therapists need to develop a united front, a shared purpose, and a shared action plan. If these are lacking, the chances of successful outcomes are diminished. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug Abuse Treatment Outcome Study (DATOS): Treatment Evaluation Research in the United States.

Much of what is known about typical drug abuse treatment outcomes comes from a series of large-scale national prospective longitudinal treatment evaluation studies supported by the National Institute on Drug Abuse over the past 3 decades. An overview of the historical context, research design, and findings from the Drug Abuse Reporting Program (DARP) and the Treatment Outcome Prospective Study (TOPS) is presented. The Drug Abuse Treatment Outcome Study (DATOS), a multisite cooperative agreement, is the latest and most advanced in this research designed to understand drug abuse treatment. DATOS investigators are conducting analyses in 4 thematic areas: health services research, retention and engagement in treatment, the life course of treated addicts, and policy-relevant treatment outcome studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The agreement among urological experts on the diagnostic management of patients with common urological problems

OBJECTIVE: To assess the level of agreement among randomly selected international urologists on the diagnostic management of patients with prostate cancer, bladder cancer, urinary stones or lower urinary tract symptoms (LUTS) arising from benign prostatic hyperplasia (BPH). METHODS: A computer program was used to provide an unbiased format of 53 simulated patients, comprising 13 with prostate cancer, 10 with bladder cancer, 10 with stones in the upper urinary tract and 20 with LUTS from BPH. For each case, the history was provided to the user while information from 60 diagnostic tests could be chosen interactively. Thirty-three university-based urologists participated in the study. The probability that a certain test was used by them in a certain patient [P(test)] and the related costs (Swedish 1995 prices) were recorded. The probability that two urologists would agree (relative measure of agreement, RMA) on whether or not to use one particular test in a certain case was RMA(test) = P(test)2 + [1-P(test)]2 and the mean of this RMA(test) for a certain patient [RMA(case)] was used as a measure of the inter-individual agreement among the urologists on the diagnostic management. The significance levels of the generalized kappa statistic, KG, were also calculated. The correlation between the RMA(case) and the diagnostic groups was analysed. RESULTS: The KG was statistically significant for all cases; the RMA(case) was significantly correlated with the diagnostic groups (rs = 0.86). The agreement in the diagnostic management was the strongest for stones, then for bladder cancer and prostate cancer, and the weakest for BPH. The mean cost for the diagnostic evaluation for one case varied from $455 to $1771 (mean 898) and varied in the diagnostic groups, i.e. $1718 for prostate cancer, $947 for bladder cancer, $400 for stones and $594 for BPH. CONCLUSION: The diagnostic management of urological patients varies greatly among urological experts from the industrial world. As a consequence, the related diagnostic costs might vary by about 400% if prices were similar everywhere. The agreement on the diagnostic management of cases is strongly correlated to the diagnosis. LUTS from BPH seems to be managed with the poorest agreement.     

Engagement in psychological treatment for functional neurological symptoms--Barriers and solutions.

This naturalistic study explores how many patients with functional neurological symptoms referred for specialist psychotherapy engage with and complete treatment, and whether routinely recorded demographic or clinical features predict engagement. Of 77 consecutive patients referred, 14.3% were considered unsuitable for therapy and excluded from between group comparisons, 23.4% did not attend any appointments, 20.8% unilaterally discontinued therapy, and 41.6% completed treatment. 66.6% of patients starting therapy completed. Older patients were more likely to engage in or complete therapy (p = .05). There were no significant differences between groups in terms of specific functional symptoms, comorbidity, predisposing, precipitating and perpetuating, or social factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of emotional engagement and habituation on exposure therapy for PTSD.

This study examined 2 process variables, emotional engagement and habituation, and outcome of exposure therapy for posttraumatic stress disorder. Thirty-seven female assault victims received treatment that involved repeated imaginal reliving of their trauma, and rated their distress at 10-min intervals. The average distress levels during each of 6 exposure sessions were submitted to a cluster analysis. Three distinct groups of clients with different patterns of distress were found: high initial engagement and gradual habituation between sessions, high initial engagement without habituation, and moderate initial engagement without habituation. Clients with the 1st distress pattern improved more in treatment than the other clients. The results are discussed within the framework of emotional processing theory, emphasizing the crucial role of emotional engagement and habituation in exposure therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Low-cost contingency management in community clinics: Delivering incentives partially in group therapy.

This study examined the feasibility and effectiveness of prize-based contingency management (CM) when incentives for attendance were administered in group therapy and incentives for abstinence were administered in individual meetings. Three community substance abuse treatment programs participated in this two-phase, crossover design study. Outpatients (N = 103) entering treatment who met diagnostic criteria for cocaine, opiate, and alcohol abuse or dependence were recruited. During the standard condition, participants received standard treatment and submitted breath and urine samples that were tested for alcohol, cocaine, and opiates twice weekly during Weeks 1-6 and once weekly during Weeks 7-12. During the CM condition, participants received the same standard treatment and sample and attendance monitoring, plus the opportunity to win prizes for negative samples and treatment attendance. Demographic information and substance abuse history were evaluated at intake, and posttreatment substance use (toxicology results and self-report) was evaluated at Month 6 and Month 9 follow-up interviews. Primary outcomes were weeks retained in treatment and longest duration of sustained abstinence (LDA). LDA was significantly greater in CM-condition participants, but weeks retained did not differ between groups. Rates of substance use were lower in CM participants at Month 9 but not at Month 6. This study suggests that it is feasible to deliver incentives for attendance in group therapy, but that further research is needed to understand the modest effects on attendance. Strengths and limitations of this study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evaluation of a "target problem" approach to outcome measurement.

Examined the agreement among 3 sources (patients, therapists, and independent judges) in their evaluation of psychotherapeutic improvement for 25 outpatients in group psychotherapy. Sources used a "target problem" approach that involved constructing an ideographic problem list for each patient before entering therapy. After 8 and 12 mo of therapy, they rated improvement on each of the individualized problems. Sources did not generally agree either on the content of Ss' problems or on Ss' improvement, even when assessment of agreement was limited to specific problem areas. Furthermore, mean target problem improvement ratings were highly correlated with simple global ratings made by each source, suggesting that the elaborate problem identification procedure was unnecessary. These findings, typical for psychotherapy outcome research, suggest psychometric weaknesses in ideographic assessment approaches that have been gaining popularity. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Goal consensus and collaboration.

There are differences in the extent to which patient and therapist agree on psychotherapy goals and work together in the helping relationship. This article reviews the empirical research on the relation between psychotherapy outcome and patient-therapist goal consensus and collaboration. Research results suggest that psychotherapy outcome is enhanced when agreement on therapeutic goals and collaborative involvement (often assessed by patient cooperation, role involvement, and homework compliance) are present during the course of therapy. When therapists and patients demonstrate cooperative and affiliative behavior, and when patients are actively involved in the patient role, better outcomes can be expected. We discuss therapeutic practices based on these findings, emphasizing the involvement of therapist and patient in a process of shared decision-making where goals are frequently discussed and agreed upon. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Change in attachment anxiety is associated with improved depression among women with binge eating disorder.

The study examined if the relationship between change in attachment insecurity and target symptom outcomes was moderated by treatment type. Women (N = 66) with binge eating disorder (BED) were randomly assigned to two treatment types: group cognitive-behavioral therapy (GCBT) or group psychodynamic-interpersonal psychotherapy (GPIP). Results indicated significant positive pre- to posttreatment changes in all attachment insecurity scales, but no difference between GCBT and GPIP on these changes. Change in attachment anxiety was related to improved depression for women completing GPIP, but not for women completing GCBT. This indicated a moderating effect of treatment type in explaining the relationship between change in attachment anxiety and improved depression. Changes in attachment anxiety may be important for symptom outcomes related to psychodynamic-interpersonal therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-Behavioral and Humanistic Group Treatment for Children With Learning Disabilities: A Comparison of Outcomes and Process.

The authors of this study examined the outcomes and processes of 2 types of group treatment--cognitive-behavioral treatment groups (CBTG) and humanistic group therapy (HGT)--offered to 200 elementary schoolchildren in a center for students with learning disabilities in Israel. Results indicated that the addition of either type of group treatment to individual academic assistance was more effective than the latter alone on most measures. In fact, on the majority of measures, group treatment without academic assistance was more effective than just individual assistance. Finally, HGT was more effective than CBTG on most measures. Most of the outcomes were sustained at follow-up, and some even increased from termination to follow-up, although effect sizes were quite low. Process measures included the Client Behavior System and the therapist Helping Skills System, which were measured at 5 points in time. Differences between the 2 treatment types were revealed on both process measures, including differences in the growth curve of these behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analytic review of the effectiveness of inpatient group psychotherapy.

The effectiveness of inpatient group therapy was estimated in a meta-analysis of 24 controlled and 46 studies with pre-post-measures published between 1980 and 2004. Diagnosis, theoretical orientation and the role of the group in the particular treatment setting were used to examine differential effectiveness. Beneficial effects were found for inpatient group therapy in controlled studies (d = 0.31) as well as in the studies with pre-post-data (d = 0.59). Differences in the homogeneity of patient improvement effect sizes were found across different diagnostic categories. Furthermore, greater improvement was exhibited in mood disorder patients when compared to mixed, psychosomatic, post traumatic stress disorder (PTSD), and schizophrenic patients replicating recent findings from meta-analyses of outpatient group treatment. A comparison between controlled studies and pre-post-measure studies indicated no improvement for waitlist patients which contradicts previous reports. Implications for therapy and future research are discussed within the context of methodical considerations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Safety at work: A meta-analytic investigation of the link between job demands, job resources, burnout, engagement, and safety outcomes.

In this article, we develop and meta-analytically test the relationship between job demands and resources and burnout, engagement, and safety outcomes in the workplace. In a meta-analysis of 203 independent samples (N = 186,440), we found support for a health impairment process and for a motivational process as mechanisms through which job demands and resources relate to safety outcomes. In particular, we found that job demands such as risks and hazards and complexity impair employees' health and positively relate to burnout. Likewise, we found support for job resources such as knowledge, autonomy, and a supportive environment motivating employees and positively relating to engagement. Job demands were found to hinder an employee with a negative relationship to engagement, whereas job resources were found to negatively relate to burnout. Finally, we found that burnout was negatively related to working safely but that engagement motivated employees and was positively related to working safely. Across industries, risks and hazards was the most consistent job demand and a supportive environment was the most consistent job resource in terms of explaining variance in burnout, engagement, and safety outcomes. The type of job demand that explained the most variance differed by industry, whereas a supportive environment remained consistent in explaining the most variance in all industries. (PsycINFO Database Record (c) 2010 APA, all rights reserved)