Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system.

Objective: Outcome research has documented worsening among a minority of the patient population (5% to 10%). In this study, we conducted a meta-analytic and mega-analytic review of a psychotherapy quality assurance system intended to enhance outcomes in patients at risk of treatment failure. Method: Original data from six major studies conducted at a large university counseling center and a hospital outpatient setting (N = 6,151, mean age = 23.3 years, female = 63.2%, Caucasian = 85%) were reanalyzed to examine the effects of progress feedback on patient outcome. In this quality assurance system, the Outcome Questionnaire–45 was routinely administered to patients to monitor their therapeutic progress and was utilized as part of an early alert system to identify patients at risk of treatment failure. Patient progress feedback based on this alert system was provided to clinicians so that they could intervene before treatment failure occurred. Meta-analytic and mega-analytic approaches were applied in intent-to-treat and efficacy analyses of the effects of feedback interventions. Results: Three forms of feedback interventions—integral elements of this quality assurance system—were effective in enhancing treatment outcome, especially for signal alarm patients. Two of the three feedback interventions were also effective in preventing treatment failure (clinical support tools and the provision of patient progress feedback to therapists). Conclusions: The current state of evidence appears to support the efficacy and effectiveness of feedback interventions in enhancing treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The complete psychotherapy treatment planner.

Reviews the book, The complete psychotherapy treatment planner by Arthur E. Jongsma Jr. and Mark Peterson (see record 1995-97453-000). The call for documentation of treatment effectiveness and an accountability of process has spawned a genre of treatment guides intended to help psychotherapists develop a practical framework through which they can meet these expectations. This text by Jongsma and Peterson is first quality in that it is both user friendly and has the depth and comprehensiveness necessary for thorough, accurate, and systematic recording. The format of the text is a six step process for developing a treatment plan applied to 34 clinical problem areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Combined treatment for children with learning disorders.

The causes of learning disorders are numerous and, although some learning difficulties can be remedied by special educative measures only, many such problems, especially when they are more severe represent a disorder of the total personality. In such a case a diagnosis must be established by a team of different specialists. After a careful evaluation a treatment programme is planned and a choice is made among various specific therapies. Very often the treatment of learning disorders must take into account more or less important emotional factors. A combined approach of psychotherapy and remedial teaching is sometimes essential to attain some success in helping a child. Such a combination of treatments requires close cooperation between psychotherapist and special teacher. Their respective roles have to be frequently clarified and both gain in understanding of the child needs through mutual communication. Following the evolution of a child from two points of view demonstrates more and more clearly how the intellectual processes necessary for learning are subject to inhibiting patterns that are observed in neurotic defense mechanisms against emotional conflicts. In some instances this practical knowledge would be necessary to understand why a child does not profit from remedial measures and to determine how new techniques are to be used to help him. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frequency of treatment and change in psychotherapy.

To test the hypothesis that frequency of weekly interview has a selective effect on psychological changes in patients in individual psychotherapy, 133 VA outpatients were randomly assigned to 3 schedules: twice, once, and bi-weekly. Changes were measured by tests based on objective evaluation of personality characteristics and assessed after 4 mo., 8 mo., and 12 mo. of therapy. The results failed to confirm that there was any major support for the hypothesis that frequency of contact produced differences in personality changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotic enhancement of cognitive-behavioral interventions for pain: An analogue treatment study.

Recent meta-analyses have shown that adding hypnosis enhances the effectiveness of cognitive behavioral psychotherapy. This hypnotic enhancement effect was evaluated in the analogue treatment of pain. Individuals scoring in the high (n=135) and low (n=150) ranges of hypnotic suggestibility were randomly assigned to 1 of 6 conditions: Stress Inoculation Training, the same treatment provided hypnotically, nonhypnotic analgesia suggestions, hypnotic analgesia suggestions, a hypnotic induction treatment, or a control condition. The 5 analogue treatments reduced experimental pain more than the control condition, but were not different from one another. Under circumstances optimized to detect an enhancement effect, neither Stress Inoculation Training nor analgesia suggestions produced more relief when delivered in a hypnotic context than identical treatments provided nonhypnotically. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using grounded theory to develop treatment strategies for multicontextual trauma.

This article presents a model for developing treatment strategies for multicontextual trauma--trauma in complex contexts in which no evidence-based treatment is available. The model conceptualizes trauma as shattering the assumptive world, and it conceptualizes recovery as reconstructing the assumptive world. The reconstruction process occurs in 3 stages: (a) safety, (b) reprocessing, and (c) integration, within which 3 issues recur--(a) strength, (b) connection, and (c) meaning. The article analyzes the recovery process for 2 medical illnesses--acquired physical disability and stem cell transplant for multiple myeloma--and presents guidelines for using the model to make treatment decisions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early withdrawal from mental health treatment: Implications for psychotherapy practice.

[Correction Notice: An erratum for this article was reported in Vol 46(2) of Psychotherapy: Theory, Research, Practice, Training (see record 2009-08897-009). The fourth author’s name was mistakenly left out of the author byline and table of contents. The correct author listing for this article is presented in the erratum.] Despite more than 50 years of research on client attrition from therapy, obstacles to the delivery and success of treatments remain poorly understood, and effective methods to engage and retain clients in therapy are lacking. This article offers a review of the literature on attrition, highlighting the methodological challenges in effectively addressing the complex nature of this problem. Current interventions for reducing attrition are reviewed, and recommendations for implementing these interventions into psychotherapy practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment: The evidence-based treatment debate: Toward a dialectical rapprochement.

In this commentary on Zeldow's (2009) “In Defense of Clinical Judgment, Credentialed Clinicians, and Reflective Practice,” the dialectical method is presented as a conceptual model and strategy for reconciling the division between clinical practitioners and clinical scientists in their acceptance of the need for empirically based psychological treatments and practices. Recommendations are made for (a) better integrating practitioners in the conduct of science, (b) confronting unhelpful attitudes of scientific chauvinism and imperialism, and (c) recognizing the contributions of both microlevel (process) and macrolevel (outcome) phenomena in psychotherapeutic practice and its scientific investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of From conflict to resolution: Strategies for diagnosis and treatment of distressed individuals, couples, and families.

Reviews the book, From conflict to resolution: Strategies for diagnosis and treatment of distressed individuals, couples, and families by Susan Heitler (see record 1990-97228-000). The title of Heitler's book, although cumbersome, reflects well the heroic scope of her effort. She will not partake of the contemporary obsession for minimodels, so reassuringly precise, so frustratingly narrow. No, she will settle for nothing less than a comprehensive model of clinical work, a single framework capable of embodying all types of therapy with all types of clients. From one perspective, the grandiosity of this ambition seems laughably anachronistic, more befitting the early rather than the late twentieth century. From a slightly different viewpoint, however, the dramatic scope emerges as startlingly modern. After all, for some time now the myriad voices of eclecticism have cried for a serviceable infrastructure, a defensible and robust strategy for the integration of endlessly proliferating techniques. Heitler has given us such a framework. It arrives in the deceptively simple, pleasingly familiar concept of conflict. She defines conflict as "a situation in which seemingly incompatible elements exert force in opposing or divergent directions," and flatly states her assumption that "the health of any given system, be it an individual, couple, or group, can be seen as a function of its ability to negotiate conflicts." The focus of her work is not so much upon the content of various conflicts, but rather the underlying process through which they are handled. This is a book designed for immediate practical utility: It is replete with tables listing interventions for various problems, and it is fleshed out at every possible point with voluminous case material. Still, the value of this work resides not in its encyclopedic compendium of techniques, but rather in its integrative vision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapeutic and other hospital treatment criteria: The dilemma.

Inconsistent findings with regard to the result of treatment was assumed to be, at least in part, a function of different criteria for improvement utilized. Data regarding 66 items involving test material, demographic, clinical history, and follow-up information were intercorrelated and the matrix factor-analyzed. 7 relatively unrelated factors were found, but of all the items, only one seemed to be related to good post-hospital adjustment: a group therapy rating. It was concluded that a universal criterion for evaluating therapy was not found, but that personal interaction within the hospital was worthy of further investigation. From Psyc Abstracts 36:04:4IE98F. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Barriers to implementing treatment integrity procedures: Survey of treatment outcome researchers.

Treatment integrity refers to implementing interventions as intended. Teatment integrity is critically important for experimental validity and for drawing valid inferences regarding the relationship between treatment and outcome. Yet, it is rarely adequately addressed in psychotherapy research. The authors examined barriers to treatment integrity implementation by surveying psychotherapy researchers. Results indicate that lack of theory and guidelines on treatment integrity procedures, as well as time, cost, and labor constraints, were regarded as strong barriers. The lack of general knowledge about treatment integrity and the lack of editorial requirement for reporting integrity procedures were also perceived as barriers to its implementation. However, psychotherapy researchers indicated awareness of the importance of treatment integrity for the experimental validity of a study and did not regard lack of its appreciation as a barrier for implementing integrity procedures. Further, a higher number of endorsed barriers predicted lower adequacy of treatment integrity procedures in the authors' own research. Recommendations for improving how integrity is addressed include journal and editorial enforcement of treatment integrity implementation, funding for integrity procedures, and provision of specific guidelines. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting frequency of treatment visits in community-based youth psychotherapy.

The current study examines factors associated with the number of treatment visits attended by a youth and/or family, including sociodemographic variables, youth clinical characteristics and parent/family characteristics at intake, therapist characteristics, and treatment entry characteristics. A total of 57 therapists in two publicly funded youth mental health clinics and 169 youths and parents from the therapists' combined caseloads were included in the study. Negative binomial regression was used to examine whether factors within these domains predict the number of treatment visits in this community-based sample. Both therapist and treatment entry characteristics significantly predicted the frequency of treatment visits. Specifically, youth self report of higher symptom severity and stronger parent-youth treatment goal agreement were associated with a higher number of treatment visits. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of manual-based training on treatment fidelity and outcome: A review of the literature on adult individual psychotherapy.

The authors examine training issues related to the use of treatment manuals in psychotherapy outcome research. In particular, they examine methodological considerations such as the operationalization of manual-based training, trainer effects, therapist variables that mediate training, issues related to experimental design, and the choice and definition of appropriate dependent variables. The research literature indicates that manual-based training can produce technical adherence. Improvements in treatment competence were seen within, as opposed to across, cases. Researchers have been unable to draw strong links between treatment fidelity and patient outcomes. The review concludes that the limited focus on training studies in the manual-based treatment field compromises conclusions drawn from psychotherapy outcome research that relies on manuals to ensure a uniform delivery of the experimental variable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The integration of psychotherapies.

Reviews the book, The integration of psychotherapies by Alvin R. Mahrer with a Foreword by John C. Norcross (see record 1989-97512-000). Mahrer has written the book for those who are learning, teaching, supervising, and trying to integrate psychotherapies. In the book he is trying to answer the following questions: What are the various strategies that are used for integrating psychotherapies? How do the several strategies fare comparatively in their feasibility, workability, and chances for success in integrating psychotherapies? What are the likely consequences for the field of psychotherapy of pursuing each of the strategies? Is integration good or bad for the field of psychotherapy? On the basis of his study of the various strategies for integrating psychotherapies, what recommendations are warranted? This book is a valuable intellectual contribution to the development of theory in psychotherapy. The process of attempting to integrate psychotherapies is inevitable, and by producing this thoughtful and scholarly work Mahrer has helped to raise the quality of the integration effort. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping Strategies in Bulimia Nervosa Treatment: Impact on Outcome in Group Cognitive-Behavioral Therapy.

This study's purpose was to examine the extent to which participants (N = 143) receiving cognitive-behavioral therapy for bulimia nervosa (BN) reported implementing therapeutic strategies to abstain from BN behaviors, and to assess whether use of specific strategies predicts outcome at treatment end and 1- and 6-month follow-up. Frequency of outcome expectancies (OE), stimulus-response prevention (SRP), and social support-seeking (SSS) strategies significantly increased by end of treatment. By 1-month follow-up, use of SSS, not OE or SRP, declined significantly relative to treatment end. Although frequency of coping strategy use at treatment end did not predict 1-month BN symptom remission, SSS use at 1-month follow-up predicted 6-month remission. Findings highlight the importance of social support to maintain treatment gains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A measure of increased temporal perspective in successfully treated adolescent delinquent boys.

The proposition that the temporal dimension of fantasy, which is usually restricted in delinquent adolescents, could be extended by suitable psychotherapy was tested and confirmed. Using time spans in TAT-type stories as the measure of temporal perspective, comparison was made between stories told by 10 delinquent boys before and after vocationally oriented psychotherapy, as compared to stories told by 10 matched, untreated controls. Increase in prospective fantasy was greatest in stories told to cards designed to tap self-image and control of aggression. Increase in past-oriented fantasies was greatest in stories told to control of aggression cards. Changes in certain fantasy measures correlated with changes in practical achievement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing and adjusting for dependent observations in group treatment research using multilevel models.

Group treatment data are nested by design, that is, clients nested in groups. Dependence associated with the nesting of group intervention data can inflate Type I error rates, which poses unique challenges to group treatment researchers. This article evaluates the extent and variability of dependence in data taken from 3 previously published randomized clinical trials of group psychotherapy. Three methods of assessing dependence by calculating intraclass correlation coefficients (ρ) were examined. Results showed great variability in ρs across studies, across methods of calculating ρ, and across outcome variables. The distribution of ρs suggested that the amount of dependence in the data was moderate. Two methods of addressing dependence in grouped treatment data through multilevel modeling were used. These methods resulted in minimally compromised statistical power compared with results from uncorrected data. These 2 methods may allow researchers to reliably assess their group treatments. Group intervention researchers are encouraged to consider their assumptions and conceptualizations of treatment change, and to choose corresponding methods of assessing for and addressing ρ. (PsycINFO Database Record (c) 2010 APA, all rights reserved)