The Relationship Between Dropout and Outcome in Naturalistic Cognitive Behavior Therapy

Dropout from psychotherapy is frequent and limits the benefits patients can receive from treatment. The study of factors associated with dropout has the potential to yield strategies to reduce it. This study analyzed data from a large sample of adults (N = 1,092) receiving naturalistic cognitive behavioral therapy (CBT) to test the hypotheses that dropouts, as compared to completers, had (1) higher symptom severity at treatment termination, (2) a slower rate of symptom change during treatment, and (3) a higher odds that the therapist rated treatment as ending for reasons related to poor outcome. Results showed that although dropouts ended treatment with higher symptom severity than completers, dropouts and completers did not differ in their rate of symptom change during treatment, suggesting that dropouts had higher symptom severity at termination because they received fewer sessions of treatment, not because their symptoms changed at a slower rate. Dropout was also associated with a higher odds of having a therapist-rated termination reason indicating a poor outcome, suggesting that dropout is more likely if patients are dissatisfied with some aspect of the therapy outcome or process. These findings suggest that strategies for monitoring and enhancing patient satisfaction with the process and outcome of treatment may help patients stay in treatment longer and end treatment with fewer symptoms than if they had dropped out.     

A Propensity Score Analysis of Homework Adherence-Outcome Relations in Cognitive Behavioral Therapy for Depression

Little is known about whether or not a consistently high level of homework adherence over the course of therapy benefits patients. This question was examined in two samples of patients who were receiving individual Cognitive Behavioral Therapy (CBT) for depression (Ns = 128 [Sequenced Treatment Alternatives to Relieve Depression: STAR-D] and 183 [Continuation Phase Cognitive Therapy Relapse Prevention: C-CT-RP]). Logistic and linear regression and propensity score models were used to identify whether or not clinician assessments of homework adherence differentiated symptom reduction and remission, as assessed by the Hamilton Depression Rating Scale-17 (HDRS-17), the Quick Inventory of Depressive Symptomatology–Self-Reported Scale (QIDS-SR), and the QIDS–Clinician Scale (QIDS-C). CBT-related response and remission were equally likely between both high and low homework adherers in both studies and in all models. But in propensity adjusted models that adjusted for session attendance, for both the STAR-D and C-CT-RP samples, greater homework adherence was significantly associated with greater response and remission from depression in the first and last 8 sessions of CBT. Our results suggest that homework adherence can account for response and remission early and late in treatment, with adequate session attendence.     

Associations between prenatal substance exposure,prenatal violence victimization,unintended pregnancy,and trauma exposure in childhood in a clinical setting

Given the importance of early prevention and intervention strategies for children exposed to trauma, detection of early risk factors for exposure to traumatic events in childhood is critical. The present study examined associations between three known prenatal risk factors that characterize environmental instability in utero—prenatal substance exposure, prenatal violence victimization, and unintended pregnancy—and child exposure to interparental violence and other adverse experiences in a sample of 198 mother–child dyads (M child age = 44.48 months) referred to a hospital clinic for treatment following exposure to trauma. Prenatal substance and violence exposure were associated with child trauma exposure, and prenatal violence victimization was also associated with maternal severity ratings of traumatic exposures. Unintended pregnancy was not associated with child trauma exposure or severity. These findings expand our understanding of prenatal risk factors for trauma exposure in childhood and, specifically, highlight prenatal substance exposure and violence victimization as risk factors for subsequent exposure to trauma in early childhood. Results suggest that prenatal prevention and intervention programs should target reducing maternal substance use and in-utero exposure to violence.     

Symptomatic distress and effectiveness of psychological treatments delivered at a nationwide student counseling service

The aim of this study is to investigate the effectiveness of student counseling in Denmark and to compare the symptomatic distress among student counseling clients with that of Danish outpatients. The pre-intervention level of self-reported symptomatic distress among 1256 students closely paralleled that of psychiatric outpatients. Participants in the intervention study were the 739 student clients with two or more counseling sessions. For the 530 (71.7%) participants with both pre- and post-measurements, the mean pre–post Cohen’s d effect size (ES) was .76 on the Global Severity Index of the Symptom Check List-90-Revised. An intention-to-treat analysis of all 739 clients resulted in an ES of .59. The number of recovered clients according to the Jacobson and Truax criteria was 295 (68.8%) of the 429 (80.9%) clients above the clinical cut-off at pre-intervention, while 66 (12.5%) of the 530 clients reliably deteriorated. The mean number of sessions was 5.0. Individual counseling, number of sessions, and ending counseling in agreement predicted better outcome. In line with results from other countries, this study may indicate that in Denmark student counseling is an effective intervention for a highly needy clientele, even though a high proportion of clients deteriorated (12.5%) or dropped out (31.7%).     

How to study the ‘quality of psychoanalytic treatments’ and their long‐term effects on patients' well‐being: A representative,multi‐perspective follow‐up study3

How can we study the ‘quality of psychoanalytic treatments’? The authors attempt to answer this question by discussing a naturalistic, multi‐perspective and representative follow‐up study of psychoanalyses and long‐term psychoanalytic psychotherapies. We studied a representative sample (n = 401) of all the patients who had terminated their psychoanalytic treatments with members of the German Psychoanalytical Association (DPV) between 1990 and 1993. Between 70 and 80 per cent of the patients achieved (average 6.5 years after the end of treatment) good and stable psychic changes according to the evaluations of the patients themselves, their analysts, independent psychoanalytic and non‐psychoanalytic experts, and questionnaires commonly applied in psychotherapy research. The evaluation of mental health costs showed a cost reduction through fewer days of sick leave during the seven years following the end of long‐term psychoanalytic treatments. The results achieved using non‐psychoanalytical instruments are complemented by the richness of the idiosyncratic findings, gained by the psychoanalytic research instruments.     

When less is more: An exploration of psychoanalytically oriented hospital‐based treatment for severe personality disorder4

This paper discusses the main findings of a prospective study based at the Cassel Hospital, a centre dedicated to the psychoanalytically informed residential treatment of severe personality disorders. The results‐showing that significantly greater improvements on a number of outcome indicators were found in patients exposed to the psychoanalytically informed treatment programmes compared to a general psychiatric approach based on management and pharmacotherapy alone‐underscores the importance and the centrality of the psychoanalytic input in the treatment of severe personality disorders. However, the results of the study also suggested that some features of long‐term hospital treatment might carry the risk of iatrogenic and anti‐therapeutic effects for a sub‐group of patients with severe borderline core pathology. The authors present the clinical and psychodynamic implications of the study results based on an understanding of the internal and interpersonal mode of functioning of borderline patients.     

Maternal Coping Skills as a Moderator Between Depression and Stressful Life Events: Effects on Children's Behavioral Problems in an Intervention Program

In this study, I report secondary analyses using data from the Infant Health and Development Program (IHDP). The IHDP included parent-targeted as well as child-targeted components as an integral part of early intervention programs. I examined three questions: (1) Do the IHDP early intervention services enhance adaptive maternal coping skills? (2) Do maternal coping skills moderate the relationship between stressful life events and maternal depression? (3) Are maternal coping skills associated with children's behavioral scores? Mothers in the treatment group have more adaptive coping skills than follow-up only mothers, and these effects are moderated by maternal characteristics. Adaptive coping skills moderate the effects of negative life events on maternal depression. Adaptive maternal coping skills are significantly associated with fewer behavioral problems for children at age three. These effects are moderated by the intervention. Implications for early intervention programs are discussed.     

Empirically Documenting Clinically Significant Change in Rational Emotive Behavior Therapy

The purpose of the present article is to outline the conceptual foundation and practical methodology of the Jacobson-Truax Clinically Significant Change index, derived from psychotherapy outcome research. This way of considering what constitutes clinically significant change in psychotherapy puts a premium on social validation. It empowers clinicians to evaluate the meaningfulness of their client's progress and to communicate that progress to third parties such as other clinicians, researchers, and insurers. Application of the method is demonstrated in the case of a client treated with Rational Emotive Behavior Therapy (REBT). The discussion focuses on the advantages of this procedure for satisfying the intellectual interest of the practitioner-scientist and for furthering informed discussion of the value in various applications of REBT to clinical problems.     

心理咨询过程-效果研究现状及展望

心理咨询过程-效果研究考察咨询过程变量对咨询效果的影响。以人为中心流派、认知流派、行为流派、精神分析流派等都为该研究领域提供了理论基础。主要研究内容有咨询师的反应方式、会谈中的当事人行为、工作同盟、会谈中的重要内容等过程变量与效果的关系。该领域积累的成果还不多,这可能与过程-效果关系本身的复杂性有关,同时研究方法尚有许多欠缺,如考察复杂关系时使用的研究设计过于简单、测量工具不统一导致结果难以比较,有些测量工具不成熟信效度不高。未来的研究除了努力克服这些问题外,还应多考虑理论构建、内隐变量的调节和中介作用、当事人变量,在研究方法上应更为综合和多样化     

结果的接近性对正性结果评价影响的电生理证据

结果的接近性是指对已发生事件的实际结果与在心理上的理想结果或期待结果之间差距的接近程度。实验采用事件相关电位技术和类老虎机赌博任务探讨了结果的接近性对正性结果评价的影响。(1)行为评定结果表明, 结果的接近性不同水平诱发了不同的情绪体验, “差一点输”的赢钱使被试更多感到庆幸, “最理想”的赢钱使被试感到高兴; 结果的接近性也影响了随后trial的反应时, 与“一般”的赢钱和“最理想”的赢钱相比, “差一点输的”赢钱后的下一个trial中被试的反应时明显变长。(2)脑电结果表明, 结果的接近性不同水平诱发了不同的FRN和P300, 与“一般”的赢钱和“最理想”的赢钱相比, “差一点输”的赢钱诱发了波幅更大的FRN和波幅更大潜伏期更长的P300。这说明结果的接近性明显地影响了正性结果的认知评价加工。