Enhancing the effect of psychotherapy through systematic client feedback in outpatient mental healthcare:A cluster randomized trial

Objective: Systematic client feedback (SCF), the regular monitoring and informing of patients’ progress during therapy to patient and therapist, has been found to have effects on treatment outcomes varying from very positive to slightly negative. Several prior studies have been biased by researcher allegiance or lack of an independent outcome measure. The current study has taken this into account and aims to clarify the effects of SCF in outpatient psychological treatment. Method: Outpatients (n = 1733) of four centers offering brief psychological treatments were cluster randomized to either treatment as usual (TAU) or TAU with SCF based on the Partners for Change Outcome Management System (PCOMS). Primary outcome measure was the Outcome Questionnaire (OQ-45). Effects of the two treatment conditions on treatment outcome, patient satisfaction, dropout rate, costs, and treatment duration were assessed using a three-level multilevel analysis. DSM-classification, sex, and age of each patient were included as covariates. Results: In both analyses, SCF significantly improved treatment outcome, particularly in the first three months. No significant effects were found on the other outcome variables. Conclusions: Addition of systematic client feedback to treatment as usual, is likely to have a beneficial impact in outpatient psychological treatment. Implementation requires a careful plan of action. Clinical or methodological significance of this article: This study, with large sample size and several independent outcome measures, provides strong evidence that addition of systematic client feedback to outpatient psychological treatment can have a beneficial effect on treatment outcome (symptoms and wellbeing), particularly in the first three months. However, implementation requires a careful plan of action

The effect of therapist characteristics on the use and outcome of systematic client feedback in outpatient mental healthcare

ObjectiveTherapist characteristics are known to affect treatment outcome in general and could also influence the use of systematic client feedback (SCF). The current study explores the effect of feedback orientation, regulatory focus, self-efficacy, attitude towards feedback resources and perceived feedback validity on the use and outcome of SCF in outpatient mental healthcare.MethodThe data of therapists (n = 12) and patients (n = 504) of two outpatient centres offering brief psychological treatment were analysed when SCF, based on the Partners for Change Outcome Management System (PCOMS), was added to treatment as usual. The data of therapists were obtained through a therapist questionnaire composed of relevant characteristics from feedback studies in social and organizational psychology. The effect on the use of SCF was analysed using logistic regression; whereas, the effect on outcome was assessed using a two-level multilevel analysis. Regular use of SCF and the Outcome Questionnaire (OQ-45) were used as outcome variables. DSM-classification, sex and age of each patient were included as covariates.ResultsHigh perceived feedback validity significantly increased the use of SCF. No significant therapist characteristics effects were found on outcome, but high promotion focus was associated with treating more complex patients.ConclusionsThe perceived feedback validity of SCF is likely to have an influence on its use and is probably affected by the changes in the organizational climate

Anomalous thermodynamics at the micro-scale

Particle motion at the micro-scale is an incessant tug-of-war between thermal fluctuations and applied forces on one side, and the strong resistance exerted by fluid viscosity on the other. Friction is so strong that completely neglecting inertia - the overdamped approximation - gives an excellent effective description of the actual particle mechanics. In sharp contrast with this result, here we show that the overdamped approximation dramatically fails when thermodynamic quantities such as the entropy production in the environment is considered, in presence of temperature gradients. In the limit of vanishingly small, yet finite inertia, we find that the entropy production is dominated by a contribution that is anomalous, i.e. has no counterpart in the overdamped approximation. This phenomenon, that we call entropic anomaly, is due to a symmetry-breaking that occurs when moving to the small, finite inertia limit. Strong production of anomalous entropy is traced back to intense sweeps down the temperature gradient.Comment: 4 pages, 1 figure, supplementary information uploaded as a separate pdf file (see other formats link

Effective bet-hedging through growth rate dependent stability

Microbes in the wild face highly variable and unpredictable environments and are naturally selected for their average growth rate across environments. Apart from using sensory regulatory systems to adapt in a targeted manner to changing environments, microbes employ bet-hedging strategies where cells in an isogenic population switch stochastically between alternative phenotypes. Yet, bet-hedging suffers from a fundamental trade-off: Increasing the phenotype-switching rate increases the rate at which maladapted cells explore alternative phenotypes but also increases the rate at which cells switch out of a well-adapted state. Consequently, it is currently believed that bet-hedging strategies are effective only when the number of possible phenotypes is limited and when environments last for sufficiently many generations. However, recent experimental results show that gene expression noise generally decreases with growth rate, suggesting that phenotype-switching rates may systematically decrease with growth rate. Such growth rate dependent stability (GRDS) causes cells to be more explorative when maladapted and more phenotypically stable when well-adapted, and we show that GRDS can almost completely overcome the trade-off that limits bet-hedging, allowing for effective adaptation even when environments are diverse and change rapidly. We further show that even a small decrease in switching rates of faster-growing phenotypes can substantially increase long-term fitness of bet-hedging strategies. Together, our results suggest that stochastic strategies may play an even bigger role for microbial adaptation than hitherto appreciated

3-D Visualization and Inter-Session Comparison for Robotic Assisted Bladder Cancer Screening

Over 570,000 new cases of bladder cancer are diagnosed worldwide every year. It is essential to detect new tumors as early as possible to reduce the mortality rate. In addition, the muscle invasiveness of lesions should be quantified to determine the optimal treatment plan.Within the "Next-gen in-vivo cancer diagnostics" research project we propose a new cystoscopy instrument consisting of an optical coherence tomography (OCT) sensor, a camera and a light source, mounted on the tip of a concentric tube robot (CTR). The camera images could then be used to create 3-D reconstructions of the bladder wall and to quantifiy changes in its texture between successive cystoscopy sessions. In addition, the camera could guide the OCT sensor to investigate the bladder wall structure at the locations of possible tumors in order to investigate the malignancy and muscle invasiveness.This research specifically reports on creating 3-D reconstructions of bladder phantoms and co-registration of successive sessions, in order to automatically detect and indicate changes in texture which might be related to the onset and growth of tumors.The results show that cystoscopy images of the bladder could be reconstructed in 3-D and subsequently projected to a 2-D atlas. Registrations of successive sessions were effectively co-registered with help of the TPS algorithm and the system was able to automatically detect all six images of tumors which were added between the two sessions

The effect of an e-learning supported Train-the-Trainer program on implementation of suicide guidelines in mental health care.

AbstractBackgroundRandomized studies examining the effect of training of mental health professionals in suicide prevention guidelines are scarce. We assessed whether professionals benefited from an e-learning supported Train-the-Trainer programme aimed at the application of the Dutch multidisciplinary suicide prevention guideline.Methods45 psychiatric departments from all over the Netherlands were clustered in pairs and randomized. In the experimental condition, all of the staff of psychiatric departments was trained by peers with an e-learning supported Train-the-Trainer programme. Guideline adherence of individual professionals was measured by means of the response to on-line video fragments. Multilevel analyses were used to establish whether variation between conditions was due to differences between individual professionals or departments.ResultsMultilevel analysis showed that the intervention resulted in an improvement of individual professionals. At the 3 month follow-up, professionals who received the intervention showed greater guideline adherence, improved self-perceived knowledge and improved confidence as providers of care than professionals who were only exposed to traditional guideline dissemination. Subgroup analyses showed that improved guideline adherence was found among nurses but not among psychiatrists and psychologists. No significant effect of the intervention on team performance was found.LimitationsThe ICT environment in departments was often technically inadequate when displaying the video clips clip of the survey. This may have caused considerable drop-out and possibly introduced selection bias, as professionals who were strongly affiliated to the theme of the study might have been more likely to finish the study.ConclusionsOur results support the idea that an e-learning supported Train-the-Trainer programme is an effective strategy for implementing clinical guidelines and improving care for suicidal patients.Trial registrationNetherlands Trial Register (NTR3092 www.trialregister.nl)