Early response to psychological therapy as a predictor of depression and anxiety treatment outcomes: A systematic review and meta-analysis

Background: Previous studies indicate that early symptomatic improvement, typically observed during the first 4 weeks of psychological therapy, is associated with positive treatment outcomes for a range of mental health problems. However, the replicability, statistical significance and magnitude of this association remains unclear. Aim: The present study reviewed the literature on early response to psychological interventions for adults with depression and anxiety symptoms. Methods: A systematic review and random effects meta-analysis was conducted, including studies found in Medline, PsychINFO, SCOPUS, Web of Science, and through reference lists and reverse citations. Results: Twenty-five eligible studies including 11091 patients measured early response and examined associations with post-treatment outcomes. It was possible to extract and/or calculate effect size data from 15 studies to conduct a meta-analysis. A large pooled effect size (g = 0.87 [95 % CI: 0.63, 1.10] p < .0001) indicated that early responders had significantly better post-treatment outcomes compared to cases without early response, and this effect was larger in anxiety (g = 1.37) compared to depression (g = 0.76) measures. Most studies were of good quality and there was no evidence of publication bias. The main limitations concerned insufficient statistical reporting in some studies, which meant that the meta-analysis only included 60% of reviewed studies, and it was not possible to examine effect sizes according to different outcome questionnaires. Conclusions: There is robust and replicated evidence that early response to therapy is a reliable prognostic indicator for depression and anxiety treatment outcomes

Ciudades en un mundo de ciudades: El gesto comparativo

Cities exist in a world of cities and thus routinely invite a comparative gesture in urban theorizing. However, for some decades, urban studies have analytically divided the world of cities into, for example, wealthier and poorer, capitalist and socialist, or into different regional groupings of cities, with subsequently very little comparative research across these divides. Interest in drawing comparisons among different cities has escalated in an era of “globalization”, as economic and social activities as well as governance structures link cities together through spatially extensive flows of various kinds and intense networks of communication. Nonetheless, scholars of urban studies have been relatively reluctant to pursue the potential for international comparative research that stands at the heart of the field. Where an interest in globalization has drawn authors to explicit exercises in comparison, both the methodological resources and the prevalent intellectual and theoretical landscape have tended to limit and even undermine these initiatives. This article seeks, first, to understand why it is that in an intrinsically comparative field with an urgent contemporary need for thinking across different urban experiences, there has been relatively little comparative research, especially comparisons that stretch across the global North-South divide, or across contexts of wealthier and poorer cities. Secondly, through a review of existing strategies for comparing cities, the article considers the potential for comparative methodologies to overcome their limitations to meet growing demands for international and properly post-colonial urban studies. Finally, it proposes a new phase of comparative urban research that is experimental, but with theoretically rigorous foundations

Using psychoeducation and role induction to improve completion rates in cognitive behavioural therapy

Background: Pre-treatment role induction interventions have been suggested to potentially enhance attendance and clinical outcomes in psychotherapy. Aims: This study aimed to evaluate the effects of a programme of 3 transdiagnostic seminars (TDS) for patients with common mental disorders accessing CBT in primary care. TDS included CBT psychoeducation and role induction. Methods: A random sample of patients (N = 49) participated in TDS followed by CBT (TDS+CBT) and they were compared to matched controls (N = 49) accessing usual CBT. TDS participants rated the relevance and quality of this intervention using an acceptability questionnaire (AQ). Treatment completion (vs. dropout) rates were compared across groups using chi-square tests. Post-treatment changes in depression (PHQ-9) and anxiety (GAD-7) symptoms were compared between groups using analysis of covariance controlling for potential confounders. Analyses were based on intention-to-treat principles. Results: Mean AQ ratings of the TDS intervention were comparable across diagnostic groups (p = .05). Treatment completion rates were significantly higher (p = .02) in the TDS+CBT group (87.8%) by comparison to usual CBT (68.8%). However, no significant differences in post-treatment symptom changes were found for depression (p = .34) or anxiety measures (p = .71). Conclusions: Incorporating a psychoeducational role induction prior to CBT significantly improved treatment retention, but not overall symptom reductions

Closing the science-practice gap: Introduction to the special issue on psychological interventions for comorbid addictions and mental health problems

Guest editorial: Introduction to the special issue on psychological interventions for dual diagnosis

Towards personalized allocation of patients to therapists

Objective: Psychotherapy outcomes vary between therapists, but it is unclear how such information can be used for treatment planning or practice development. This proof-of-concept study aimed to develop a data-driven method to match patients to therapists. Method: We analyzed data from N = 4,849 patients who accessed cognitive–behavioral therapy in U.K. primary care services. The main outcome was posttreatment reliable and clinically significant improvement (RCSI) on the Patient Health Questionnaire–9 (PHQ-9) depression measure. Machine-learning analyses were applied in a training sample (N = 2,425 patients treated by 68 therapists in Year 1), including a chi-squared automatic interaction detector (CHAID) algorithm and a random forest (RF) algorithm. The predictive models were cross-validated in a statistically independent test sample (N = 2,424 patients treated by the same therapists in Year 2) and evaluated using odds ratios (ORs) adjusted for baseline depression severity. Results: We identified subgroups of therapists that were differentially effective for highly specific subgroups of patients, yielding 17 classes of patient-to-therapist matches. The overall base rate of RCSI in the sample was 40.4%, but this varied from 10.5% to 69.9% across classes. Cases classed by the prediction algorithms as expected responders in the test sample were ∼60% more likely to attain posttreatment RCSI compared with those classed as nonresponders (adjusted ORs = 1.59, 1.60; p < .001). Conclusions: Machine-learning approaches could help to improve treatment outcomes by enabling the strategic allocation of patients to therapists and therapists to supervisors

Adverse impact of neighbourhood socioeconomic deprivation on psychological treatment outcomes : the role of area-level income and crime

Aim: Socioeconomic deprivation is known to be associated with depression and anxiety symptoms. This study aimed to investigate the influence of several domains of neighbourhood deprivation on psychological treatment outcomes. Method: Healthcare records from 44805 patients who accessed psychological treatment were analyzed. Patient-level depression (PHQ-9) and anxiety (GAD-7) outcome measures were linked to their neighbourhood statistics, including area-level indices of income, unemployment, education, health and disability, crime, housing quality, and quality of the local environment. Linear regressions were applied to examine associations between these domains and post-treatment symptom severity after controlling for patient-level and service-level variables. Results: Neighbourhood income and crime rates were associated with depression and anxiety symptoms after controlling for covariates, explaining 4% to 5% of variability in treatment outcomes. Patients living in low-income areas required a higher number of treatment sessions to benefit from therapy. Conclusions: Patients living in economically deprived neighbourhoods tend to have poorer depression and anxiety treatment outcomes and require lengthier interventions

A systematic review and meta-analysis of the good-enough level (GEL) literature

The “good-enough level” (GEL) model proposes that people respond differentially to psychotherapy, and that the typical curvilinear “dose-response” shape of change may be an artifact of aggregation. We conducted a systematic review and meta-analysis of the GEL literature to examine (a) whether different subgroups of adults accessing psychotherapy respond to therapy at different rates and (b) whether the shape of change is linear or nonlinear. This review was preregistered on PROSPERO. Fifteen studies were synthesized (n = 114,123), with 10 included across two meta-analyses (n = 46,921; n = 41,515). Systematic searches took place using Medline, APA PsycInfo and Scopus databases. A key inclusion criterion was that cases must be stratified by treatment length to examine the GEL. In support of the GEL, there was no overall association between treatment duration and outcomes (r = −0.24, 95% confidence interval [CI: −0.70, 0.36], p = .27). Longer treatments were associated with higher baseline symptom scores (r = 0.15, 95% CI [0.08, 0.22], p < .001) and slower rates of change. Different shapes of change were also evidenced: Curvilinear responses were more often found in shorter treatments, while linear shapes were more often found in longer treatments. However, findings varied depending on methodological criteria used. Although rates of change varied in line with the GEL, most people nonetheless responded within defined boundaries as described in the dose-response literature. We therefore refer to the notion of “boundaried responsive regulation” to describe the relationship between treatment duration and outcomes

Social inequalities in the demand, supply and utilisation of psychological treatment

Introduction: Socioeconomic deprivation is associated with higher prevalence of mental disorders but poor access to care. We conducted a national workforce survey to examine the demand, supply and utilisation of primary care psychological services. Aim: To understand the variability in the rates of access to psychological care in different geographical areas. Method: This was a cross-sectional survey of Improving Access to Psychological Therapies (IAPT) services. Data were collected from 144 services covering 180 local areas in England, using a freedom of information request. The access gap (AG) was defined as the percentage of cases that did not receive treatment, from the wider pool of cases referred for psychological care. We examined correlations between the demand (number of referrals), and supply (workforce size) of psychological care with local area prevalence rates of common mental disorders and the index of multiple deprivation (IMD). Regression analyses were used to assess if the variability in AG may be explained by IMD and workforce size, controlling for local population statistics. Results: Workforce size was weakly correlated with the IMD (r = 0.16, p = 0.04) and prevalence rates (r = 0.16, p = 0.03). The AG was significantly associated with IMD, number of referrals, prevalence rates and treatment waiting times, but not with workforce size. Together, these variables explained approximately 26% of variance in the AG. Conclusions: Socioeconomic deprivation is associated with psychological service utilisation, irrespective of the demand–supply function, particularly when contrasting the poorest and most affluent areas

Towards territorial product-service systems: A framework linking resources, networks and value creation

While many models for sustainable product-service systems (PSS) integrate the multi-actor perspective, few provide insights on how the territory in which actors implement the system influences its sustainability. This paper explores the implementation of a territorial PSS at a city or regional scale as a means to structuring value networks and enhancing its sustainability potential. The research combines a multidisciplinary literature review with two exploratory sustainable PSS cases in packaging and cloth baby diapers. The paper proposes a framework explaining how sustainable PSS providers develop territorial networks that consider a diversity of actors from civil, industrial, and public spheres to mobilize resources for value creation at organizational, network, and territorial levels. It identifies contextual factors, such as proximity, social embeddedness of relations, and the visions that influence the consolidation and sustainability of the territorial PSS networks. The empirical cases show the development of territorial networks enhances embed social relations among actors and enables the sustainable PSS concept to adapt to locally articulated sustainability principles and priorities. The paper discusses the implications of this approach for PSS for sustainability managers and designers. The study fills a gap by showing the importance of integrating a diversity of territorial actors as a pre-condition for PSS to contribute to the sustainability transitions and resilience of territories. Future research may validate the proposed framework and focus on identifying opportunities and barriers for the territorial PSS approach in different contexts such as industries and company sizes