Jaime Delgadillo

The University of Sheffield | Sheffield · Department of Psychology (Faculty of Science)

Background: Previous research suggests that using outcome feedback technology can enable psychological therapists to identify and resolve obstacles to clinical improvement. This study aimed to evaluate the effectiveness of an outcome feedback quality assurance system applied in stepped care psychological services. Methods: This multi-site cluster r...

IMPORTANCE: Depression is a major cause of disability worldwide. Although empirically supported treatments are available, there is scarce evidence on how to effectively personalize psychological treatment selection. OBJECTIVE: To compare the clinical effectiveness and cost-effectiveness of 2 treatment selection strategies: stepped care and stratifi...

Several interventions are available for the treatment of depression, including empirically supported psychological and pharmacological interventions. Despite this, less than half of patients have an optimal response to their initial intervention and the care pathway for many is characterized by a prolonged trial-and-error process to search for the...

Despite the ubiquity of guided self-help (GSH) interventions in Primary Care psychological services, there have been no previous studies of the relationship between the competence of qualified practitioners and treatment outcomes. This study compared competence-outcome associations in two types of GSH. Competence and clinical outcome measures were...

Background: Oxytocin, popularly known as the “social hormone”, has wide implications for the regulation of socially relevant cognitions, emotions and behaviors. Individual differences in oxytocin may be relevant to mental health treatment outcomes, given the centrality of the therapeutic relationship in psychotherapy. Methods: This systematic revie...

Background: Although psychological interventions can be effective for the treatment of major depressive disorder, some patients’ symptoms persist or rapidly recur after therapy. This study aimed to synthesise research findings on predictors and moderators of treatment response for persisting forms of depression, such as chronic, recurrent, and trea...

Objective: To test the predictive accuracy and generalisability of a personalised advantage index (PAI) model designed to support treatment selection for Post-Traumatic Stress Disorder (PTSD). Method: A PAI model developed by Deisenhofer et al. (2018) was used to predict treatment outcomes in a statistically independent dataset including archival r...

Background Depression is one of the most prevalent mental health conditions in the world. However, the heterogeneity of depression has presented obstacles for research concerning disease mechanisms, treatment indication, and personalization. The current study used network analysis to analyze and compare profiles of depressive symptoms present in co...

We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients’ treatment response with standardized measures,...

Background:Some patients return for further psychological treatment in routine services, although it is unclear how common this is, as scarce research is available on this topic. Aims:To estimate the treatment return rate and describe the clinical characteristics of patients who return for anxiety and depression treatment. Method:A large dataset (N...

Background: Feedback-informed treatment (FIT) has been shown to reduce the gap between more and less effective therapists. However, interactions between therapist characteristics and feedback utilisation are under-researched and not well understood. Methods: The IAPT-FIT Trial was a clinical trial where therapists were randomly assigned to a FIT gr...

Objective. This study investigated if patients’ experience of an initial assessment may be associated with outcome expectations, and with subsequent treatment attendance. Method. The sample comprised n = 6051 patients with depression/anxiety disorders, nested within k = 148 assessing therapists. Multilevel modelling (MLM) was used to examine therap...

There has been a growing emphasis on dissemination of empirically supported treatments. Dissemination, however, should not be restricted to treatment. It can and, in the spirit of the scientific-practitioner model, should also involve research. Because it focuses on the investigation of clinical routine as it takes place in local settings and becau...

Background: Sudden gains occur in a range of disorders and treatments and are of clinical and theoretical significance if they can shed light on therapeutic change processes. This study investigated the relationship between sudden gains in panic symptoms and preceding cognitive change during cognitive behavioural therapy (CBT) for panic disorder....

This study aimed to develop and test algorithms to determine the individual relevance of two psychotherapeutic change processes (i.e., mastery and clarification) for outcome prediction. We measured process and outcome variables in a naturalistic outpatient sample treated with an integrative treatment for a variety of diagnoses (n = 608) during the...

Background: Guided self-help (GSH) for anxiety is widely implemented in primary care services because of service efficiency gains, but there is also evidence of poor acceptability, low effectiveness and relapse. Aims: The aim was to compare preferences for, acceptability and efficacy of cognitive-behavioural guided self-help (CBT-GSH) versus cog...

Objective: Conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy of individual humanistic-experiential therapies (HEPs) for depression. Method: Database searches (Scopus, Medline, and PsycINFO) identified RCTs comparing any HEP intervention with a treatment-as-usual (TAU) control or active a...

Objective: To evaluate the efficacy of different approaches to personalization in psychological therapy. Method: This was a systematic review and meta-analysis of randomized controlled trials that compared the mental health outcomes of personalized treatment with standardized treatment and other control groups. Eligible studies were identified thr...

Objective: To provide a research review of the components and outcomes of routine outcome monitoring (ROM) and recommendations for research and therapeutic practice. Method: A narrative review of the three phases of ROM – data collection, feeding back data, and adapting therapy – and an overview of patient outcomes from 11 meta-analytic studies....

Objectives: The literature regarding the effectiveness of long-term psychological interventions delivered in tertiary care is scarce. This study sought to quantify and evaluate outcomes delivered in a UK tertiary care psychotherapy service against equivalent service benchmarks. Design: A retrospective analysis of outcomes on the Outcome Question...

Background. The manner in which heuristics and biases influence clinical decision-making has not been fully investigated and the methods previously used have been rudimentary. Aims. Two studies were conducted to design and test a trial-based methodology to assess the influence of heuristics and biases. Specifically, with a focus on how practitioner...

Background The aim of this study was to investigate and model the interactions between a range of risk and protective factors for suicidal ideation using general population data collected during the critical phase of the COVID-19 pandemic. Methods Bayesian network analyses were applied to cross-sectional data collected 1 month after the COVID-19 l...

Objective: Treatment outcomes are known to vary according to therapist and clinic/organization (therapist effect, clinic effect). Outcomes may also vary according to the neighborhood where a person lives (neighborhood effect), but this has not previously been formally quantified. Evidence suggests that deprivation may contribute to explaining such...

Objective The occurrence of dropout from psychological interventions is associated with poor treatment outcome and high health, societal and economic costs. Recently, machine learning (ML) algorithms have been tested in psychotherapy outcome research. Dropout predictions are usually limited by imbalanced datasets and the size of the sample. This pa...

Background: Occupational burnout is highly prevalent in the mental healthcare workforce and associated with poorer job satisfaction, performance and outcomes. Aims: To evaluate the effects of the Mind Management Skills for Life Programme on burnout and wellbeing. Methods: N=173 mental health nurses were recruited from the English National Health...

Background: Approximately 1.5 million referrals are made to Improving Access to Psychological Therapy (IAPT) services annually. However, treatment is received in less than half of cases due to ineligibility or non-attendance. The aim was to explore risk factors for non-attendance at the initial two IAPT appointments following referral. Methods: An...

The Dysfunctional Attitude Scale (DAS; Weissman, 1979) measures depression related enduring beliefs and is one of the core measures of cognitive behavioral (CBT) research and theory. It has been the central marker of etiological claims of CBT, and so any change to the understanding of the composition of the DAS would have potentially far-reaching i...

Purpose: This review presents a comprehensive evaluation of the effectiveness of routinely delivered psychological therapies across inpatient, outpatient and University-based clinics. Methods: This was a pre-registered systematic-review of studies meeting pre-specified inclusion criteria (CRD42020175235). Eligible studies were searched in three dat...

Background: Early dropout hinders the effective adoption of brief psychological interventions and is associated with poor treatment outcomes. This study examined if attendance and depression treatment outcomes could be improved by matching patients to either face-to-face or computerized low-intensity psychological interventions. Methods: Archival...

Currently, no reports exist on the phenomenon of early response in humanistic-experiential therapies. This study investigated the prognostic value of early response on posttreatment outcomes in person-centered experiential therapy (PCET) for depression within the English Improving Access to Psychological Therapies program. The design of the study w...

Computers are capable of learning how to solve complex problems. The emergence of machine learning (ML) represents a major advance for the field of mental health. ML algorithms can be trained to recognize subgroups of people with similar symptoms (diagnosis), to estimate the probability of recovery from these symptoms (prognosis), to make a judgeme...

Objective: Some psychotherapists are more effective than others, which means that patients’ treatment outcomes partly depend on therapist effects (TEs). This study investigated whether the use of progress feedback influences TE. Method: Data from N = 4,549 participants and 131 therapists across six clinical trials of progress feedback were analyzed...

Outcome measurement in the field of psychotherapy has developed considerably in the last decade. This review discusses key issues related to outcome measurement, modeling, and implementation of data-informed and measurement-based psychological therapy. First, an overview is provided, covering the rationale of outcome measurement by acknowledging so...

Dropout during psychological intervention is a significant problem. Previous evidence for associations with socioeconomic deprivation is mixed. This study aimed to review the evidence for associations between deprivation and dropout from contemporary adult psychological interventions for common mental disorders (CMDs). Systematic review, narrative...

Objective: To provide a comprehensive assessment of the association between psychological treatment adherence/competence/integrity (ACI) and clinical outcomes. Method: The review protocol was preregistered (CRD42020193889). Studies that assessed ACI-outcome relationships for adult psychotherapy were searched across three databases (Scopus, PsycI...

Background One in two patients seeking help for substance use disorders (SUDs) has clinically significant depression symptoms. This co-occurrence impairs treatment outcomes, but limited evaluation of the implementation of evidence-based interventions has taken place. Methods This pilot randomized controlled trial (RCT) assessed the feasibility and...

Objective: The Personalized Advantage Index (PAI) is a method to guide treatment selection by investigating which of two or more treatments is optimal for a given individual. Recently, it was shown that, on average, twice-weekly sessions of psychotherapy for depression lead to better outcomes compared to once-weekly sessions. The present study app...

Background: Prior research indicates that patients’ personality traits are associated with psychotherapy processes and outcomes. However, the potential relevance of the therapist’s personality traits is less understood. Methods: This is a scoping review of studies investigating associations between therapists’ personality traits with treatment pro...

Objectives: To investigate associations between alcohol use, psychological treatment attendance and clinical outcomes. Methods: We analysed electronic health records for N=7,986 patients accessing psychological treatment for common mental disorders. Data were collected for pre-treatment alcohol use (average units per week) and severity of dependenc...

Background: In theory, depression is thought to be associated with deficits in adaptive and excesses in maladaptive coping strategies. This study aimed to investigate associations between coping strategies and depression treatment outcomes. Method: Participants (N = 126) completed measures of adaptive and maladaptive coping strategies before and af...

This chapter addresses fundamental issues of change in psychotherapy: how to measure, monitor, predict change, and provide feedback on treatment outcome. The chapter starts with a historical overview, covering several approaches applied to measure change in psychotherapy research. We proceed with a description of classical concepts to evaluate chan...

In the modern history of psychotherapy, understanding the individual patient and how to optimize treatment for each individual has been an important challenge. For the therapist, personalization often has meant deciding which treatments to offer based on clinical assessment and formulation, or deciding moment-to-moment what techniques to employ, gi...

Background: Previous reviews indicate that depressed patients with a comorbid personality disorder (PD) tend to benefit less from psychotherapies for depression and thus personality pathology needs to be the primary focus of treatment. This review specifically focused on Cognitive Behavioural Therapy (CBT) studies examining the influence of comorbi...

For many years, psychiatrists have tried to understand factors involved in response to medications or psychotherapies, in order to personalize their treatment choices. There is now a broad and growing interest in the idea that we can develop models to personalize treatment decisions using new statistical approaches from the field of machine learnin...

Background: Depression is a heterogeneous condition, with multiple possible symptom-profiles leading to the same diagnosis. Descriptive depression subtypes based on observation and theory have so far proven to have limited clinical utility. Aim: To identify depression subtypes and to examine their time-course and prognosis using data-driven meth...

Background Feedback-informed treatment (FIT) involves using computerized routine outcome monitoring technology to alert therapists to cases that are not responding well to psychotherapy, prompting them to identify and resolve obstacles to improvement. In this study, we present the first health economic evaluation of FIT, compared to usual care, to...

Early response is a well-established predictor of positive outcomes at the end of psychological treatments for common mental disorders. There is some prior evidence that this conclusion also applies to eating disorders, including three meta-analyses, but no moderators of that relationship have been identified. However, a number of further papers ha...

Objectives. This review sought to evaluate the effectiveness of the ‘Stress Control’ (SC) large psychoeducational 6-session group programme developed to increase access to treatment for patients with anxiety and depression. Design. Systematic review and meta-analysis (Prospero registration:CRD42020173676). Methods. Pre–post and post-treatment follo...

Background Depression often co-occurs with substance use problems and is associated with poor treatment outcomes. While the efficacy of behavioral activation (BA) has been tested in clinical trials with substance users, outcomes have not yet been quantitatively synthesized. Methods The study team performed a random effects meta-analysis of the ran...

Background: This was a multi-site evaluation of psycho-educational transdiagnostic seminars (TDS) as a pre-treatment intervention to enhance the effectiveness and utilisation of high intensity cognitive-behavioural therapy (CBT). Aims: To evaluate the effectiveness of TDS combined with high intensity CBT (TDS+CBT) versus a matched sample receiving...

Video abstract: https://www.youtube.com/watch?v=odRicwO-GsY Background: Common mental disorders can be effectively treated with psychotherapy, but some patients do not respond well and require timely identification to prevent treatment failure. We aimed to develop and validate a dynamic model to predict psychological treatment outcomes, and to com...

Objectives: To investigate the effectiveness of an 8-session cognitive analytic therapy (CAT) protocol for patients with anxiety and depression in the context of relational problems, personality disorder traits, or histories of adverse childhood experiences and then to compare outcomes with cognitive behavioural therapy (CBT). Methods: The study...

Background: Whilst the delivery of low-intensity group psychoeducation is a key feature of the early steps of the Improving Access to Psychological Therapies (IAPT) programme, there is little consensus regarding the skills and competencies demanded. Aims: To identify the competencies involved in facilitating CBT-based group psychoeducation in order...

Objective: Low-intensity cognitive behavioural therapy (LiCBT) can help to alleviate acute symptoms of depression and anxiety, but some patients relapse after completing treatment. Little is known regarding relapse risk factors, limiting our ability to predict its occurrence. Therefore, this study aimed to develop a dynamic prediction tool to ident...

Cognitive behavioural therapy (CBT) is an effective psychological treatment for anxiety-related disorders (anxiety disorders, post-traumatic stress disorder, and obsessive-compulsive disorder). However, relapse of anxiety symptoms is common following completion of treatment. This study aimed to identify predictors of relapse of anxiety after CBT fo...

This editorial article is a primer on key concepts and considerations for the quality appraisal of studies applying Machine Learning methods in the field of psychotherapy and mental health research.

Background: Managing the alliance is considered to be a core competency and central therapeutic change process during cognitive analytic therapy (CAT). This study examined latent trajectories of change in the alliance and their relationship to depression treatment outcomes. Design: Secondary analysis of a randomised controlled trial. Methods: A sam...

The “Good-Enough Level” (GEL) model proposes that people respond differentially to psychotherapy, and that the typical curvilinear “dose-response” shape of change may be an artefact of aggregation. We conducted a systematic review and meta-analysis of the GEL literature to examine 1) whether different sub-groups of adults accessing psychotherapy re...

The “Good-Enough Level” (GEL) model proposes that people respond differentially to psychotherapy, and that the typical curvilinear “dose-response” shape of change may be an artefact of aggregation. We conducted a systematic review and meta-analysis of the GEL literature to examine 1) whether different sub-groups of adults accessing psychotherapy re...

Objective: The Coronavirus Disease (COVID-19) pandemic and related lockdown measures have raised important questions about the impact on mental health. This study evaluated several mental health and well-being indicators in a large sample from the United Kingdom (UK) during the COVID-19 lockdown where the death rate is currently the highest in Euro...

Aims To outline the methods of a pragmatic patient preference trial in the Improving Access to Psychological Therapies (IAPT) programme comparing cognitive behavioural therapy guided self-help (CBT-GSH) with cognitive analytic therapy guided self-help (CAT-GSH). Method A partially randomised patient preference trial (PRPPT) methodology. Participan...

Objective: Many patients relapse within one year of completing effective cognitive behavioural therapy (CBT) for depression and anxiety. Residual symptoms at treatment completion have been demonstrated to predict relapse, and so this study used network analyses to improve specificity regarding which residual anxiety and depression symptoms predict...

Objectives Improving Access to Psychological Therapies (IAPT) is a national‐level dissemination programme for provision of evidence‐based psychological treatments for anxiety and depression in the United Kingdom. This paper sought to review and meta‐analyse practice‐based evidence arising from the programme. Design A pre‐registered (CRD42018114796...

Risk and prognosis are central concepts in precision medicine, referring to the probability of future outcomes in people with a particular health condition. Prognosis research has a long history in epidemiology, medicine, and public health. According to the PROGnosis RESearch Strategy (PROGRESS) framework,¹ there are 4 broad types of prognostic res...

Objective: Psychotherapy outcomes vary between therapists, but it is unclear how such information can be used for treatment planning or practice development. This proof-of-concept study aimed to develop a data-driven method to match patients to therapists. Methods: We analyzed data from N=4,849 patients who accessed cognitive behavioral therapy in...

(Open access: https://www.karger.com/Article/FullText/507793) Deciding on the number of psychotherapy sessions to satisfactorily treat a patient is a vital clinical as well as economic issue in most mental health systems worldwide. Based on a systematic review, we identified 20 naturalistic samples across 8 countries (published between 2015-2019)....

Within the Routine Outcome Monitoring System “OQ-Analyst”, the questionnaire “Assessment for Signal Cases” (ASC) supports therapists in detecting potential reasons for not-on-track trajectories. Factor analysis and a machine learning algorithm (LASSO with 10-fold cross-validation) were applied and potential predictors of not-on-track classification...

Aim: To investigate if therapists’ personality influences their patients’ treatment outcomes. Methods: N = 4,052 patients were treated by 69 therapists, including 36 Psychological Wellbeing Practitioners (PWPs) and 33 Cognitive Behavioural Therapists (CBTs). Therapists completed the NEO-PI-R personality inventory, they reported years of clinical ex...

Background: Cognitive behavioural therapy (CBT) is effective for the treatment of common mental health problems, but the number of sessions required to maximise improvement in routine care remains unclear. Aim: This study aimed to examine the dose-response effect in low (LiCBT) and high (HiCBT) intensity CBT delivered in stepped care services. Me...

Researchers increasingly use meta-analysis to synthesize the results of several studies in order to estimate a common effect. When the outcome variable is continuous, standard meta-analytic approaches assume that the primary studies report the sample mean and standard deviation of the outcome. However, when the outcome is skewed, authors sometimes...

Objective: Depression is a highly common mental disorder and a major cause of disability worldwide. Several psychological interventions are available, but there is a lack of evidence to decide which treatment works best for whom. This study aimed to identify subgroups of patients who respond differentially to cognitive behavioural therapy (CBT) or...

Clinical guidelines for the treatment of depression and anxiety recommend psychological interventions organised in a stepped care model, where patients initially access low intensity guided self-help followed by high intensity psychotherapies if their symptoms persist. The Leeds Risk Index (LRI) is a data-driven tool that enables clinicians to prof...

Aim: Socioeconomic deprivation is known to be associated with depression and anxiety symptoms. This study aimed to investigate the influence of several domains of neighbourhood deprivation on psychological treatment outcomes. Method: Healthcare records from 44805 patients who accessed psychological treatment were analysed. Patient-level depression...

Background: Previous studies indicate that early symptomatic improvement, typically observed during the first 4 weeks of psychological therapy, is associated with positive treatment outcomes for a range of mental health problems. However, the replicability, statistical significance, and magnitude of this association remain unclear. Aim: The curr...

Aim: The study aimed to investigate the impact of socio-demographic similarity on the probability of attending an adequate dose of a psychoeducational group intervention (≥4 of 6 sessions). Method: The sample comprised 2071 patients (63% female, 93% White, 15% unemployed, mean age 43) who received the Stress Control intervention in the UK’s nation...

The dose-response effect refers to the relationship between the dose (e.g., length, frequency) of treatment and the subsequent probability of improvement. This systematic review aimed to synthesise the literature on the dose-response effect in routine psychological therapies delivered to adult patients with mental health problems. Twenty-six studi...

Background Cognitive behavioural therapy (CBT) is an effective psychological treatment for major depressive disorder, although some patients experience a return of symptoms after finishing therapy. The ability to predict which individuals are more vulnerable to deterioration would allow for targeted interventions to prevent short-term relapse and l...

Variability is intrinsic to all human activities and psychotherapy is no exception. However, trials methodology is not suited to investigating and building our knowledge about variability. By contrast, the paradigm of practice-based evidence, which focuses on routine practice, is a better way of researching the phenomenon of variability. We outline...