A systematic review and meta-analysis of dropout rates from dialectical behaviour therapy in randomized controlled trials

ABSTRACT

Dropout is an important factor that may compromise the validity of findings from randomized controlled trials (RCTs) of dialectical behaviour therapy (DBT). We conducted a targeted meta-analytic review of dropout from RCTs of DBT, with the aims of (1) calculating average rates of dropout from DBT; (2) investigating factors that moderate dropout; (3) examining whether dropout rates from DBT differ to control interventions; (4) synthesising reasons for dropout. Forty RCTs of DBT met full inclusion criteria. The weighted mean dropout rate was 28.0% (95% CI = 23.6, 32.9). Dropout rates were not related to target disorder, dropout definition, delivery format, therapist experience, and therapist adherence. Unexpectedly, dropout rates were significantly higher in trials that offered telephone coaching and utilized a therapist consultation team. DBT dropout rates did not significantly differ to dropout rates from control interventions. Few trials reported reasons for dropout, and there was little consistency in the reported reasons. Findings suggest that over one in four patients drop out from DBT in RCTs. This review highlights the urgency for future trials to explicitly report detail pertaining to patient dropout, as this may assist in the development of strategies designed to prevent future dropouts in RCTs of DBT.     

CONSIDERATION OF THE ROLE OF PSYCHOTHERAPY IN REDUCING THE RISK OF SUICIDE IN AFFECTIVE DISORDERS – A CASE STUDY

In this paper material is presented from a patient with a diagnosis of a recurrent affective disorder and exhibiting resistance to engaging in the work of therapy alongside the emergence of active suicidal intent. Supervision can help in containing intensely disturbing feelings in the therapist and aid in identifying the underlying psychosis. Through exploration of the counter‐transference feelings, the therapist can become attuned to a playing down of the psychosis by the patient and alert other involved professionals. Technically, the challenge remains one of how to make an impact in the sessions through converting a psychotic monologue into a dialogue.     

Identifying and Referring Youths at Risk for Suicide Following Participation in School‐Based Gatekeeper Training

Gatekeeper training is a core strategy of the Garrett Lee Smith Memorial Suicide Prevention Act of 2004. Using data gathered from school‐based gatekeeper trainings implemented by GLS grantees, this analysis examines training and gatekeeper factors associated with (1) identification and referral patterns and (2) services at‐risk youths receive. Time spent interacting with youths was positively correlated with the number of gatekeeper identifications and knowledge about service receipt. Gatekeepers who participated in longer trainings identified proportionately more at‐risk youths than participants in shorter trainings. Most gatekeeper trainees referred the identified youths to services regardless of training type.     

Inspection times and the selection task: What do eye-movements reveal about relevance effects?

Three experiments are reported that used eye-movement tracking to investigate the inspection-time effect predicted by Evans' (1996) heuristic-analytic account of the Wason selection task. Evans' account proposes that card selections are based on the operation of relevance-determining heuristics, whilst analytic processing only rationalizes selections. As such, longer inspection times should be associated with selected cards (which are subjected to rationalization) than with rejected cards. Evidence for this effect has been provided by Evans (1996) using computer- presented selection tasks and instructions for participants to indicate (with a mouse pointer) cards under consideration. Roberts (1998b) has argued that mouse pointing gives rise to artefactual support for Evans' predictions because of biases associated with the task format and the use of mouse pointing. We eradicated all sources of artefact by combining careful task constructions with eye-movement tracking to measure directly on-line attentional processing. All three experiments produced good evidence for the robustness of the inspection-time effect, supporting the predictions of the heuristic-analytic account.     

Tracking transitional probabilities and segmenting auditory sequences are dissociable processes in adults and neonates

Since speech is a continuous stream with no systematic boundaries between words, how do pre-verbal infants manage to discover words? A proposed solution is that they might use the transitional probability between adjacent syllables, which drops at word boundaries. Here, we tested the limits of this mechanism by increasing the size of the word-unit to four syllables, and its automaticity by testing asleep neonates. Using markers of statistical learning in neonates’ EEG, compared to adult behavioral performances in the same task, we confirmed that statistical learning is automatic enough to be efficient even in sleeping neonates. We also revealed that: (1) Successfully tracking transition probabilities (TP) in a sequence is not sufficient to segment it. (2) Prosodic cues, as subtle as subliminal pauses, enable to recover words segmenting capacities. (3) Adults’ and neonates’ capacities to segment streams seem remarkably similar despite the difference of maturation and expertise. Finally, we observed that learning increased the overall similarity of neural responses across infants during exposure to the stream, providing a novel neural marker to monitor learning. Thus, from birth, infants are equipped with adult-like tools, allowing them to extract small coherent word-like units from auditory streams, based on the combination of statistical analyses and auditory parsing cues.

Research Highlights

• Successfully tracking transitional probabilities in a sequence is not always sufficient to segment it.
• Word segmentation solely based on transitional probability is limited to bi- or tri-syllabic elements.
• Prosodic cues, as subtle as subliminal pauses, enable to recover chunking capacities in sleeping neonates and awake adults for quadriplets.

     

Can Happiness Apps Generate Nationally Representative Datasets? - a Case Study Collecting Data on People’s Happiness Using the German Socio-Economic Panel

In the last few years, apps have become an important tool to collect data. Especially in the case of data on people’s happiness, two projects have received substantial attention from both the media and the scientific world: “Track your happiness” from Killingsworth and Gilbert (Science, 330, 932-932, 2010), and “Mappiness,” from MacKerron (2012). Both happiness apps used the experience sampling method to ask people a few times per day how they feel, what they do, with whom, and where. The collected data are then displayed for the participants in simple graphs to help them understand what makes them happy and what does not. Both studies have collected considerable data without giving participants any financial rewards. But quantity is not everything that matters with respect to data collection, and thus, understanding whether nationally representative datasets can be collected using such happiness apps is crucial. To address this question, we built a new happiness app and ran a case-study with over 4000 participants of the innovation sample of the German Socio-Economic Panel (Richter and Schupp in Schmollers Jahrbuch, 135(3), 389–399, 2015). Participants were informed that the app collects data on everyday happiness after a household interview and asked whether they would like to use the app. In the first year (2015), participants did not receive any reward, and in the second year (2016), a different group of participants received a 50 Euro Amazon voucher for their participation. The results showed that our happiness app cannot generate nationally representative datasets if it is not controlled that all demographic sub-groups have access to a smartphone, are highly motivated with a sufficient reward and data is collected with quota sampling.