Multimodal therapy in an inpatient setting

Inpatient Multimodal Therapy (imt) is a residential treatment program, lasting a maximum of 36 weeks, for patients with severe neurotic symptoms. A group of 44 chronic obsessive-compulsive patients and a group of 40 chronic phobic patients were treated in order to assess the outcome and the process of treatment and to identify prognostic factors associated with the effect. At follow-up-on average, eight months after discharge-it was found that 60% had improved, 32% had remained the same, and 8% had deteriorated, indicating that, in general, the treatment was beneficial. That these effects were long-lasting is supported by the fact that, at follow-up, 78% of all patients were no longer receiving treatment, 18% were receiving outpatient or day treatment, and 4% were receiving inpatient treatment. Phobic patients appear to have gained more from the multimodal approach than did obsessive-compulsive patients, as indicated by the fact that the severity of symptoms decreased as they improved in rational thinking, assertiveness, and arousal. By contrast, obsessive-compulsive patients relapsed more than phobic patients did. This was attributed to the fact that the former gained less from the rational-emotive training, denied problems with assertiveness, and did not practice the acquired relaxation skills. It further appeared that a favorable outcome could be induced in patients who (1) expressed relatively mild symptoms in this otherwise severe group, (2) reported relatively few additional complaints, (3) could clearly indicate interpersonal problems, and (4) did not use psychotropic drugs. These prognostic factors are so widespread that not much weight can be ascribed to them. Yet they are useful for indication of imt until better predictors are found

De geprotocolleerde Interapy-behandeling van depressie via het internet; resultaten van een gerandomiseerde trial

Psychologische behandelingen via internet bieden een nieuwe mogelijkheid voor de geestelijke gezondheidszorg. In samenwerking met de Stichting Mentrum ggz Amsterdam heeft Interapy een behandeling voor depressie via internet opgezet. De behandeling bestaat uit cognitief-gedragstherapeutische interventies, zoals psycho-educatie, schrijfopdrachten, registratie, activatie, het uitdagen van negatieve automatische gedachten en terugvalpreventie. Dit artikel beschrijft de procedure, de behandeling en de resultaten van een vergelijkende studie onder cliënten die matig tot ernstig depressief waren. De cliënten die direct actief werden behandeld (N = 32) verbeterden significant meer dan de cliënten in de psycho-educatieconditie (N = 14). Deze tweede groep kreeg de actieve behandeling ongeveer twaalf weken later. De effecten waren groot. In de actief behandelde groep liet 75 procent van de cliënten klinisch relevante verbetering zien, in de psycho-educatieconditie was dat percentage 36. Uit de follow-up na zes weken bleek dat de verbeteringen standhielden