Beyond the illusion of structural change: A process priming approach to psychotherapy outcome research.

Psychoanalytically oriented psychotherapy outcome research has yet to differentiate between a psychological structure that is present but temporarily inactive and genuine change in that underlying structure. Thus, a decrease in maladaptive responding following treatment may sometimes reflect illusory structural change, with the patient remaining vulnerable to relapse in situations that activate the underlying pathogenic structure. Genuine structural change would be better assessed by deliberately seeking and failing to find evidence of the enduring presence of a pathogenic structure under conditions that typically activate that structure, using both implicit (e.g., free response) and explicit (self-report) outcome measures. Because implicit and explicit measures are differentially affected by situational variables (e.g., mood, mindset priming), rigorous psychotherapy research must use experimental techniques and multimodal assessments to assess outcome under the conditions most likely to evoke a pathological reaction in a seemingly recovered individual. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Assessing the contributions of S–O and R–O associations to differential-outcome matching through outcome reversals.

Pigeons were trained on symbolic matching with 2 samples, 2 pairs of comparisons, and different outcomes for the correct responses within each comparison pair. For one group, the 2 samples were also associated with different outcomes, whereas for another group, they were not. When the response–outcome (R–O) relations for one pair were subsequently reversed, the group trained with differential sample–outcome (S–O) associations was significantly disrupted in its performance on both reversed- and nonreversed-outcome trials. By contrast, the group trained with just differential R–O associations was disrupted only on reversed-outcome trials. These results were replicated when the outcomes on the initially nonreversed trials were then reversed. The findings indicate that differential S–O associations, when present, have a stronger influence on matching performances than differential R–O associations. They are also consistent with hierarchical and configural models of discriminative control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing a Taxonomy for Rehabilitation Outcome Measurement.

Objective: To identify and organize the elements of a taxonomy for medical rehabilitation outcome measurement. The taxonomy can serve as a working model for further expansion and development of a complete listing of measures for all of medical rehabilitation. Design: The proposed taxonomy is based on a "levels" model both qualitatively and quantitatively and was conceptualized deductively from an overall review of rehabilitation activities and inductively from a review of measures from previously presented tools for rehabilitation outcome measurement. Conclusions: The present form of the taxonomy suggests areas for expansion of domains and measures at several levels both qualitatively and quantitatively. It is suggested that a complete taxonomy of rehabilitation measures could be used as a whole or divided into parts for specific clinical practice and research purposes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What are the fundamental facts of a comparison of two treatments' outcomes?

Responds to comments by Stefan G. Hofmann (see record 2011-19228-003), Edward A. Wise (see record 2011-19228-004), Michael J. Lambert (see record 2011-19228-005), and William H. Gottdiener (see record 2011-19228-006) on the authors original article "Statistical significance testing and clinical trials" (see record 2011-19228-002). The original article is one very narrowly focused effort at studying the implications of relying on the null hypothesis significance test (NHST) for determining which psychotherapy randomized clinical trial (RCT) findings to take seriously for clinical purposes. Although there are several approaches for faulting the NHST, the matter is important and complicated enough to justify dealing, in detail, with one approach at a time. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Some more fundamental problems in clinical research: Comment on “Statistical significance testing and clinical trials”.

Comments on an article "Statistical significance testing and clinical trials" by Merton S. Krause (see record 2011-19228-002). The article provides a thought-provoking and critical discussion of the conventional statistical testing in clinical research. Krause argues that, by focusing exclusively on mean differences between groups and their statistical significance, important information about the individual participant is being ignored. This article argues a few central issues with Krause's article. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Statistical significance testing and clinical trials.

The efficacy of treatments is better expressed for clinical purposes in terms of these treatments' outcome distributions and their overlapping rather than in terms of the statistical significance of these distributions' mean differences, because clinical practice is primarily concerned with the outcome of each individual client rather than with the mean of the variety of outcomes in any group of clients. Reports of the obtained outcome distributions for the comparison groups of all competently designed and executed randomized clinical trials should be publicly available no matter what the statistical significance of the mean differences among these groups, because all of these studies' outcome distributions provide clinically useful information about the efficacy of the treatments compared. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Negative outcome in psychotherapy and what to do about it.

Reviews the book, Negative outcome in psychotherapy and what to do about it edited by Daniel T. Mays and Cyril M. Franks (1985). Negative outcome in psychotherapy is a topic of great importance to the field. The treatment of this topic by Mays and Franks is a comprehensive and ambitious one. Their goals, as outlined in the Introduction, are to 1) generate a definition of negative outcome, 2) bring some preliminary closure to the negative outcome debate, 3) identify contributing variables and 4) offer suggestions for research and treatment application. They proceed to do this through an edited volume, consisting of 14 chapters, which fall into six sections and an Appendix. Of the goals that the editors set for themselves in the Introduction, the most important one, to this reviewer's mind, was not even mentioned--that is, the development of a theoretical framework from which future research can develop. It is this synthesis that makes the book particularly valuable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome Additivity and Outcome Maximality Influence Cue Competition in Human Causal Learning.

Recent research suggests that outcome additivity pretraining modulates blocking in human causal learning. However, the existing evidence confounds outcome additivity and outcome maximality. Here the authors present evidence for the influence of presenting information about outcome maximality (Experiment 1) and outcome additivity (Experiment 2) on subsequent forward blocking. The results of Experiment 3 confirm that, with outcome maximality controlled, outcome additivity affects backward blocking but not release from overshadowing. Finally, the results of Experiment 4 demonstrate that information about outcome additivity has a similar effect on forward blocking if presented after the blocking training instead of before. The results are compatible with the idea that blocking results from inferential processes at the time of testing and not from a failure to acquire associative strength during training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing and Applying a Systematic Process for Evaluation of Clinical Outcome Assessment Instruments.

In recent years, there has been increasing demand within the mental health field for practitioners and administrators to evaluate and demonstrate the effectiveness of psychological services delivered to the populations they serve. In response to these demands, there has been a proliferation of outcome assessment instruments. The purpose of this article is to describe the development and application of a systematic process for evaluating and selecting clinical outcome measures for use by mental health organizations. A group of Veterans Affairs Medical Center psychologists systematically applied criteria to a set of brief, commonly used, self-report outcome instruments. Results of this evaluation process are discussed, and the implications for selecting outcome measures for other mental health settings and outcome measurement in general are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stages of change.

Empirical research on the stages of change has taken a number of tacks over the past 20 years. In this article, we review those published research studies that have directly examined the stages (precontemplation, contemplation, preparation, action, maintenance, and, termination) as they relate to treatment outcome, broadly defined. The cumulative evidence indicates that tailoring the therapy relationship and treatment intervention to the stage of change can enhance outcome, specifically in the percentage of patients completing therapy and in the ultimate success of treatment. Several limitations of this body of research are noted. We conclude by advancing therapeutic practices both for conventional psychotherapy with individual patients and for proactive recruitment of entire populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Control of Matching by Differential Outcome Expectancies in the Absence of Differential Sample-Outcome Associations: A serial compound view.

In this study, pigeons learned 2 separate one-to-many conditional discriminations in which they matched form samples to line and hue comparisons. Correct choices within each comparison dimension yielded differential (food vs. no-food) outcomes that were not predictable from the samples alone. At asymptote, latency to make a correct choice was shorter when food was the contingent outcome than when no food was the outcome. More important, when the samples from each task were subsequently exchanged, comparison choice varied systematically as a function of the sample and the set of new comparison alternatives that followed them. Together, these results indicate that choices were cued by differential outcome expectancies arising from serial compounds consisting of each sample and the dimensional characteristics of the comparisons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An outcome index for mental hospital patients.

"An Outcome Index for mental hospital patients is described. The index relates time out of hospital to follow-up period since first admission and weights their ratio differentially by number of readmission and releases. This index becomes relatively stable on a 2-year follow-up. It can be used as a criterion for prognostic efficiency, for efficacy of treatment, and for characterizing institutional policy." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight suppression predicts weight gain over treatment but not treatment completion or outcome in bulimia nervosa.

The authors attempted to replicate previous findings that weight suppression is a significant predictor of treatment completion and treatment outcome (M. L. Butryn, M. R. Lowe, D. L. Safer, & W. S. Agras, 2006) and weight gain over treatment (M. R. Lowe, W. Davis, D. Lucks, R. A. Annunziato, & M. L. Butryn, 2006) among women with bulimic disorders. The authors also examined 2 alternative measures of weight variability. Participants were 132 women with bulimia nervosa treated with cognitive-behavioral therapy. Participants who dropped out of treatment did not have significantly higher levels of weight suppression than did treatment completers. Among those who completed treatment, weight suppression did not significantly predict binge eating and purging at post-treatment. Weight suppression did significantly predict weight change and, in particular, weight gain (≥5 kg) over treatment. Alternative measures of weight variability did not significantly predict treatment completion or treatment outcome, but 1 measure significantly predicted weight gain over treatment. In conclusion, the authors failed to replicate the previous finding that weight suppression predicts treatment compliance and treatment outcome, but they did replicate the finding that weight suppression predicts weight gain over treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telehealth and chronic disabilities: New frontier for research and development.

The primary purpose of this special section is to address key issues and current developments in telehealth outcome research for individuals with chronic disabling conditions. The special section begins with a critical review of contemporary telehealth and disability outcome research, followed by two articles that present the findings of 2 ongoing randomized controlled telehealth trials for adults with Type 2 diabetes and rural teenagers with uncontrolled seizure disorders. Future directions for outcome research on telehealth and chronic disability are discussed across all 3 articles, particularly the need for large N studies, the use of conceptually meaningful control groups and more rigorous cost utility analyses, and studies that evaluate the "best matches" among different types of telehealth interventions, specific health care concerns, and consumer populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Use of Outcome Measures by Psychologists in Clinical Practice.

This survey investigated psychologists' use of outcome measures in clinical practice. Of the respondents, 37% indicated that they used some form of outcome assessment in practice. A wide variety of measures were used that were rated by the client or clinician. Clinicians who assess outcome in practice are more likely to be younger, have a cognitive-behavioral orientation, conduct more hours of therapy per week, provide services for children and adolescents, and work in institutional settings. Clinicians who do not use outcome measures endorse practical (e.g., cost, time) and philosophical (e.g., relevance) barriers to their use. Both users and nonusers of outcome measures were interested in similar types of information, including client progress since entering treatment, current strengths and weaknesses, and determining if there is a need to alter treatment. Implications for practicing clinicians are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empathy.

Empathy is defined, and its measurement is discussed. We then present the results of a new meta-analysis of the relation between measures of empathy and psychotherapy outcome from three perspectives (client, therapist, and observer). Variables that mediate this relationship also are discussed. The processes of change that empathy is posited to facilitate, as well as the different roles and forms that empathy may take in therapy are discussed. Results indicate that clients' and observers' perceptions that therapists understand their clients' internal experiences relate to outcome. This suggests it is important that therapists make efforts to understand their clients, and that this understanding be demonstrated through responses that address the needs of the client, as the client perceives them, on an ongoing basis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relational interpretations.

We review studies of relational interpretations as predictors of psychotherapy outcome and alliance. Investigations examining frequency of interpretations and outcome have yielded mixed findings. However, studies specifically of transference interpretations have converged toward the conclusion that high rates of transference interpretations can lead to poor outcome, particularly for patients with low quality of object relations. Several studies of the quality of interpretations have yielded consistent findings suggesting that relatively more favorable treatment outcomes are produced when therapists accurately address central aspects of patients' interpersonal dynamics. Few studies that have examined the relation between interpretations and the therapeutic alliance or tested the common clinical notion that interpretations have their greatest impact in the context of a positive alliance. Practice implications based upon this research literature are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and functional outcome following traumatic brain injury.

Objective: To investigate pre- to postinjury personality change in relation to outcomes following traumatic brain injury (TBI). Design: Prospective analysis of personality ratings, depression, and outcome using multiple regression analyses. Participants: Cohort of 3 clinical trauma groups (mild TBI, moderate-severe TBI, orthopedic injury) and their significant others (SO). Outcome Measures: Independent Living Scale, Vocational Independence Scale, and Mayo-Portland Adaptability Inventory, 1-2 years postinjury. Predictor Variables: Posttraumatic amnesia (PTA); patient and SO NEO Personality Inventory-Revised ratings of preinjury personality taken at 1-2 months postinjury. Results: Personality function was normal for all groups (regardless of rating source) and stable over time. Neuroticism, and specifically depression, accounted for small proportions of variance in functional outcome, beyond PTA. Conclusions: There is little empirical evidence for significant personality disturbance or change up to 2 years post-TBI. Personality and depression contribute modestly to functional outcomes. Results support a distinction between "personality change" and behavior change following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Session and intersession experience related to treatment outcome in bulimia nervosa.

Treatment in bulimia nervosa is challenging, with rates of successful treatments for only about 50% of all patients. This study aimed to identify predictors of outcome through secondary analysis of data from a randomized clinical trial that compared inpatient and day hospital treatment for bulimia. Process measures included assessments of patients' in-session experiences, therapeutic alliance, and therapy-related intersession experiences (ISE). ISE measures were better predictors of outcome than pretreatment variables (e.g., social adjustment) or global therapeutic alliance. Outcome at 3 month follow-up was strongly related to the ISE dimension Recreating Therapeutic Dialogue with Negative Emotions, indicating a heightened risk of failure. Prediction of outcome by these variables showed a sensitivity of 0.86 and a specificity of 0.78, and 83% of patients could be correctly classified. These results show that certain aspects of ISE may serve as early and reliable indicators of long term treatment failure, prompting alternate treatment approaches and opening new directions of research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delay discounting in current and never-before cigarette smokers: Similarities and differences across commodity, sign, and magnitude.

Research has found that nicotine-dependent individuals delay discount monetary gains at a higher rate than matched controls. Delay discount rates, however, have also been found to vary across within-subject variables such as the magnitude of the outcome (e.g., $10 or $1,000), whether the outcome constitutes a gain or a loss, and the commodity being evaluated (e.g., money or health). The present study comprehensively investigated the differences in delay discounting between current and never-before cigarette smokers and across these within-subject variables. Both groups exhibited a magnitude, sign, and commodity effect. Current smokers' delay discount rates for monetary outcomes, however, were higher than never-before smokers across all magnitudes and both signs. This trend was also found for delayed health outcomes, but failed to reach significance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)