Methodological Background of Decision Rules and Feedback Tools for Outcomes Management in Psychotherapy

Systems to provide feedback regarding treatment progress have been recognized as a promising method for the early identification of patients at risk for treatment failure in outpatient psychotherapy. The feedback systems presented in this article rely on decision rules to contrast the actual treatment progress of an individual patient and his or her expected treatment response (ETR). Approaches to predict the ETR on the basis of patient intake characteristics and previous treatment progress can be classified into two broad classes: Rationally derived decision rules rely on the judgments of experts, who determine the amount of progress that a patient has to achieve for a given treatment session to be considered “on track.” Empirically derived decision rules are based on expected recovery curves derived from statistical models applied to aggregated psychotherapy outcomes data. Examples of each type of decision rule and of feedback systems based on such rules are presented and reviewed

The Association between Treatment Components and Mental Health Outcomes Among Young Children Exposed to Violence

Background: When treating violence-exposed children, clinicians often modify psychotherapy protocols or use only a subset of treatment components (e.g., a clinical technique, strategy). However, there is little evidence of the effectiveness of individual treatment components. Our study aimed to determine: i) the best fitting factor structure of individual treatment components; ii) the association of child characteristics (i.e., demographics, treatment dosage, environmental risk factors) with mental health outcomes (i.e., post-treatment internalizing and externalizing symptoms); and iii) the association of individual treatment factors (i.e., sets of treatment components) with mental health outcomes. Methods: A sample of 459 violence-exposed children aged 1.5–5 years was examined. Principal component analyses were conducted to factor-analyze 22 child treatment components and 18 caregiver treatment components, respectively. Multiple linear regression analyses were conducted to determine the relationship between child and caregiver treatment factors and outcomes. Results: Children who received grief work showed significant improvement in externalizing symptoms. Children of caregivers who received parent training, attachment skills building, psychoeducation about domestic violence, safety planning, and anger management training showed significantly less externalizing symptom improvement. Gender, race/ethnicity, and treatment dosage were also associated with outcomes. Conclusion: This is the first study to examine treatment components in a sample of young children exposed to violence with a standardized quantitative measure. Our findings suggest that acknowledging children’s loss and sorrow expressed through externalizing behavior and helping them process bereavement may help alleviate their symptoms. Clinical recommendations are discussed

Therapist effects in outpatient psychotherapy: A three-level growth curve approach

Evidence suggests that a moderate amount of variance in patient outcomes is attributable to therapist differences. However, explained variance estimates vary widely, perhaps because some therapists achieve greater success with certain kinds of patients. This study assessed the amount of variance in across-session change in symptom intensity scores explained by therapist differences in a large naturalistic data set (1,198 patients and 60 therapists, who each treated 10 -77 of the patients). Results indicated that approximately 8% of the total variance and approximately 17% of the variance in rates of patient improvement could be attributed to the therapists. Cross-validation and extreme group analyses validated the existence of these therapist effects

The Potential Role of a Self-Management Intervention for Ulcerative Colitis: A Brief Report From the Ulcerative Colitis Hypnotherapy Trial

Inflammatory bowel diseases (IBD) are chronic inflammatory illnesses marked by unpredictable disease flares, which occur spontaneously and/or in response to external triggers, especially personal health behaviors. Behavioral triggers of flare may be responsive to disease self-management programs. We report on interim findings of a randomized controlled trial of gut-directed hypnotherapy (HYP, n = 19) versus active attention control (CON, n = 17) for quiescent ulcerative colitis (UC). To date, 43 participants have enrolled; after 5 discontinuations (1 in HYP) and 2 exclusions due to excessive missing data, 36 were included in this preliminary analysis. Aim 1 was to determine the feasibility and acceptability of HYP in UC. This was achieved, demonstrated by a reasonable recruitment rate at our outpatient tertiary care clinic (20%), high retention rate (88% total), and our representative IBD sample, which is reflected by an equal distribution of gender, an age range between 21 and 69, recruitment of ethnic minorities (~20%), and disease duration ranging from 1.5 to 35 years. Aim 2 was to estimate effect sizes on key clinical outcomes for use in future trials. Effect sizes (group × time at 20 weeks) were small to medium for IBD self-efficacy (.34), Inflammatory Bowel Disease Questionnaire (IBDQ) total score (.41), IBDQ bowel (.50), and systemic health (.48). Between-group effects were observed for the IBDQ bowel health subscale (HYP > CON; p = .05) at 20 weeks and the Short Form 12 Health Survey Version 2 (SF-12v2) physical component (HYP > CON; p < .05) at posttreatment and 20 weeks. This study supports future clinical trials testing gut-directed HYP as a relapse prevention tool for IBD

E-Care: A Telecommunications Technology Intervention for Family Caregivers of Dementia Patients

This study evaluated the effectiveness of a technology-based psychoeducational intervention for family caregivers of dementia patients. An additional objective was to determine if the intervention could be implemented by a community-based social service agency. Forty-six caregivers were randomly assigned to either a technology-based intervention or an information-only control condition. Caregivers assigned to the intervention condition reported a significant decrease in burden postintervention and those who evidenced high depression at baseline experienced a significant decline in depression. This study provides evidence that technology offers a cost-effective and practical method for delivering interventions to caregivers