Westen D, Morrison K (2001) A multidimensional meta-analysis of treatments for depression, panic and generalized anxiety Disorder: An empirical examination of the status of empirically supported therapies
The authors report a meta-analysis of high-quality studies published from 1990-1998 on the efficacy of manualized psychotherapies for depression, panic disorder, and generalized anxiety disorder (GAD) that bear on the clinical utility and external validity of empirically supported therapies. The results suggest that a substantial proportion of patients with panic improve and remain improved; that treatments for depression and GAD produce impressive short-term effects: that most patients in treatment for depression and GAD do not improve and remain improved at clinically meaningful follow-up intervals: and that screening procedures used in many studies raise questions about generalizability, particularly in light of a systematic relation across studies between exclusion rates and outcome. The data suggest the importance of reporting, in both clinical trials and meta-analyses, a range of outcome indices that provide a more comprehensive, multidimensional portrait of treatment effects and their generalizability. These include exclusion rates, percent improved, percent recovered, percent who remained improved or recovered at follow-up, percent seeking additional treatment at follow-up, and data on both completer and intent-to-treat samples.
"In contrast, some critics have suggested that studies of treatment outcome reduce or minimize comorbidity among participants (Westen & Morrison, 2001). In one review of 298 RCTs published before 2002, more than half of the articles made no mention of what their exclusionary criteria were, making it impossible to determine their clinical representativeness (Jensen-Doss, 2005). "
[Show abstract][Hide abstract] ABSTRACT: Background: Evidence-based treatments (EBTs) with a single-disorder focus have improved the potential for youth mental health care, yet may be an imperfect fit to clinical care settings where diagnostic comorbidity and co-occurring problems are commonplace. Most EBTs were developed to treat one diagnosis or problem (or a small homogenous cluster), but most clinically referred youths present with multiple disorders and problems.
Findings: Three emerging approaches may help address the comorbidity that is so common in treated youths. Conceptually unified treatments target presumed causal and maintaining factors that are shared among more than one disorder or problem area; preliminary open trials and case studies show promising results. Modular protocols combine the ‘practice elements’ that commonly appear in separate single-disorder EBTs and repackage them into coordinated delivery systems; one modular protocol, MATCH, has produced positive findings in a randomized effectiveness trial. Monitoring and Feedback Systems (MFSs) provide real-time data on client progress to inform clinical decision-making, encompassing comorbid and co-occurring problems; one study shows beneficial effects in everyday practice with diverse youth problems. Conclusions: All three approaches – conceptually unified, modular, and MFS – can be strengthened by increased research attention to treatment integrity, clinician user-appeal, design simplicity, and the infrastructure necessary for successful implementation.
Child and Adolescent Mental Health 03/2015; Advance Online Publication(3). DOI:10.1111/camh.12092 · 1.44 Impact Factor
"These experiences may be especially salient in action-oriented therapies, such as cognitivebehavioral therapy (CBT), where therapist guidance or demand might promote resistance among clients who are ambivalent about change (e.g., Leahy, 2001; Sanderson & Bruce, 2007; Westra, 2012). While CBT is widely regarded as an effective treatment for anxiety (e.g., Chambless et al., 1996), treatment nonresponse is a common occurrence, with approximately 60% of individuals with anxiety partially responding or not responding to treatment (Westen & Morrison, 2001). In the area of generalized anxiety disorder (GAD) specifically, up to half of clients are nonresponders to treatment (Hunot, Churchill, Teixeira, & Silva de Lima, 2007). "
[Show abstract][Hide abstract] ABSTRACT: Clients' resistance relates negatively to their retention and outcomes in psychotherapy; thus, it has been increasingly identified as a key process marker in both research and practice. This study compared therapists' postsession ratings of resistance with those of trained observers in the context of 40 therapist-client dyads receiving 15 sessions of cognitive-behavioral therapy for generalized anxiety disorder. Therapist and observer ratings were then examined as correlates of proximal (therapeutic alliance quality and homework compliance) and distal (posttreatment worry severity) outcomes. Although there was reasonable concordance between rater perspectives, observer ratings were highly and consistently related to both proximal and distal outcomes, while therapist ratings were not. These findings underscore the need to enhance therapists' proficiency in identifying important and often covert in-session clinical phenomena such as the cues reflecting resistance and noncollaboration.
"Clinical gains are thus expected in the follow-up assessments. Despite findings that suggest some post-treatment improvement , limited follow-up intervals are major limitations in most long-term effect studies of psychotherapy; patients are often assessed for no longer than a year after treatment (Cooper, 2008; Westen and Morrison, 2001). This trend of relatively short follow-ups appears in a systematic review of 53 high-quality comparative outcome studies examining psychotherapy for depression (Cuijpers et al., 2008a). "
[Show abstract][Hide abstract] ABSTRACT: Background: In a previous clinical controlled trial (Lopes et al., 2014), narrative
therapy (NT) showed promising results in ameliorating depressive symptoms with
comparable outcomes to cognitive-behavioral therapy (CBT) when patients completed
treatment. This paper aims to assess depressive symptoms and interpersonal problems in
this clinical sample at follow-up. Methods: Using the Beck Depression Inventory-II and
Outcome Questionnaire-45.2 Interpersonal Relations Scale, naturalistic prospective
follow-up assessment was conducted at 21 and 31 months after the last treatment
session. Results: At follow-up, patients kept improving in terms of depressive symptoms
and interpersonal problems. The odds that a patient maintained recovery from
depressive symptoms at follow-up were five times higher than the odds that a patient
maintained recovery from interpersonal problems. In the same way, the odds of a
patient never recovering from interpersonal problems were five times higher than the
odds of never recovering from depressive symptoms. Limitations: The study did not
control for the natural course of depression or treatment continuation. Conclusions: For
depressed patients with greater interpersonal disabilities, longer treatment plans and
alternative continuation treatments should be considered.
Journal of Affective Disorders 05/2014; DOI:10.1016/j.jad.2014.05.042 · 3.38 Impact Factor
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