Wolfgang Lutz

Universität Trier · Department of Psychology

Abstract Psychotherapy does not always follow a linear path. The present study explores the frequency of sudden gains and losses during the course of outpatient psychotherapy. The sample includes 1500 patients treated at three different outpatient centers. The patients were 57.4% female, and suffered primarily from anxiety and depressive disorders....

Objective: Recently, innovative statistical tools have been used to model patterns of change in psychological treatments. These tools can detect patterns of change in patient progress early in treatment and allow for the prediction of treatment outcomes and treatment length. Method: We used growth mixture modeling to identify different latent cl...

Several different approaches have been applied to identify early positive change in response to psychotherapy so as to predict later treatment outcome and length as well as use this information for outcome monitoring and treatment planning. In this study, simple methods based on clinically significant change criteria and computationally demanding g...

There are large health, societal, and economic costs associated with attrition from psychological services. The recently emerged, innovative statistical tool of complex network analysis was used in the present proof-of-concept study to improve the prediction of attrition. Fifty-eight patients undergoing psychological treatment for mood or anxiety d...

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....

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...

Introduction Routine Outcome Monitoring (ROM) has emerged as a strong candidate to improve psychotherapy processes and outcome. However, its use and implementation are greatly understudied in Latin-America. Therefore, the aim of the present pilot study conducted in Argentina was to implement a ROM and feedback system grounded on a psychometrically...

Zusammenfassung: In diesem Beitrag soll ein forschungsbasiertes und transtheoretisches Weiterbildungskonzept vorgestellt werden, das darauf abzielt, Erkenntnisse aus der Psychotherapie-Ergebnis-, Prozess-und Feedback-For-schung als offenen konzeptionellen Rahmen für die klinische Praxis und Weiterbildung zu nutzen. Diskutiert werden wichtige Fehlsc...

Die Geschichte der Psychotherapie begann gegen Ende des 19. Jahrhunderts und verlief seither eher diskontinuierlich. Es entstanden zahlreiche Verfahren bzw. Therapieschulen (einige Zählungen gehen von weit über 100 aus) mit eigenen psychopathologischen Konzepten, psychologischen Veränderungsmodellen und Fachorganisationen [1]. Die großen Therapiesc...

Derzeit erfahren psychotherapeutische Ansätze einen Wandel in Richtung eines individualisierten, modularen Organisationsprinzips. Dabei wird an gestörten Mechanismen und weniger an Störungsbildern oder Theorien von Therapieschulen angesetzt. Die Modulare Psychotherapie bietet ein Konzept von hoher Praktikabilität in der ambulanten und stationären V...

The current article presents a way of practising case formulation using technology augmentation in the context of data-informed psychotherapy. First, we explain how case formulation guides the decision-making processes in psychotherapy and how decisions made under an intuitive clinical judgement can be biased. The use of actuarial methods is pointe...

Objective: Providing therapists with feedback about their patients has been shown to be beneficial in several ways. Network models may provide a novel way to depict individual patients’ symptomatology. Ecological momentary assessment (EMA) methods are often used, so that a patient-level database can be used for the necessary calculations. Method: T...

Zusammenfassung. Theoretischer Hintergrund: Das BDI-II ist ein Selbstbeurteilungsinstrument zur Erfassung des Schweregrads einer Depression. Es liegen kaum Analysen mit Modellen aus der Item-Response-Theorie (IRT) vor. Fragestellung: Wie hoch ist die Messgenauigkeit des BDI-II über die unterschiedlichen Ausprägungen des latenten Traits (Depressivit...

Objective: The study investigated the contribution of therapists and patients to the therapeutic bond and their associations (at the within and between levels) to treatment outcome. On this aim, the social relations model (SRM, aimed to analyze dyadic interpersonal data) was implemented. Method: A novel design for individual psychotherapy studie...

Background Emotions play a key role in psychotherapy. However, a problem with examining emotional states via self-report questionnaires is that the assessment usually takes place after the actual emotion has been experienced which might lead to biases and continuous human ratings are time and cost intensive. Using the AI-based software package Non-...

Objective: Attunement is a novel measure of nonverbal synchrony reflecting the duration of the present moment shared by two interaction partners. This study examined its association with early change in outpatient psychotherapy. Methods: Automated video analysis based on motion energy analysis (MEA) and cross-correlation of the movement time-ser...

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...

Background Imagery rescripting (IR), an emotion-focused technique for processing dysfunctional core beliefs, is an increasing topic of psychotherapy research; however, the underlying mechanisms of the technique remain unclear. The results of recent studies on physiological synchrony suggest that processes such as co-regulation could play a signific...

Zusammenfassung Die Kurzform des Bielefelder Fragebogens zu Partnerschaftserwartungen (BFPE12) misst drei partnerbezogene Bindungsskalen: Akzeptanzprobleme, Öffnungsbereitschaft und Zuwendungsbedürfnis. Die vorliegende Studie untersuchte Messinvarianz und Validität des BFPE12 anhand einer klinischen (N=102) und einer nicht-klinische Stichprobe (N=1...

Continuous outcome measurement in psychotherapies has become a central research topic only in the last two decades 1. Here we provide a short introduction to the relevant concepts and discuss the opportunities and challenges of their implementation in clinical practice. Most continuous outcome measurement systems comprise short self-report question...

Objective: The therapist effect has been demonstrated in various studies. However, studies on putative therapist characteristics show heterogeneous results. Although the majority of studies have solely examined effects between therapists, a growing interest in effects within therapists has emerged. However, it remains unclear whether therapist cha...

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...

Background: Although psychotherapy has shown to be effective for most patients, about one-third of patients do not benefit or deteriorate during treatment. Technical progress has allowed the integration of routine outcome monitoring (ROM) into treatment, helping therapists detect patients at risk for a nonresponse or poor outcome early on. Psychol...

Background About 30% of patients drop out of cognitive–behavioural therapy (CBT), which has implications for psychiatric and psychological treatment. Findings concerning drop out remain heterogeneous. Aims This paper aims to compare different machine-learning algorithms using nested cross-validation, evaluate their benefit in naturalistic settings...

The augmentation of technology to the delivery of CBT has enormously increased in recent years. This commemoration of Dr. Aaron T. Beck’s contribution to the field focuses on examples such as CBT internet treatments, video treatments, but especially on data-informed CBT, precision mental health and digitally based treatment navigation systems. It e...

In recent years, network approaches to psychopathology have sparked much debate and have had a significant impact on how mental disorders are perceived in the field of clinical psychology. However, there are many important challenges in moving from theory to empirical research and clinical practice and vice versa. Therefore, in this article, we bri...

Imagery rescripting (IR), an effective intervention technique, may achieve its benefits through various change mechanisms. Previous work has indicated that client–therapist physiological synchrony during IR may serve as one such mechanism. The present work explores the possibility that therapist-led vs. client-led synchrony may be differentially ti...

Background Routine outcome monitoring can support clinicians to detect patients who deteriorate [not-on-track (NOT)] early in psychotherapy. Implemented Clinical Support Tools can direct clinicians’ attention towards potential obstacles to a positive treatment outcome and provide suggestions for suitable interventions. However, few studies have co...

Objective This study investigated symptom change trajectory for patients with persistent somatic symptoms (PSS) during psychotherapy and the association of these patterns with pre-treatment characteristics and long-term outcome. Methods Growth mixture modeling was used to identify trajectory curves in a sample of N = 210 outpatients diagnosed with...

Background: Differences in effectiveness among treatments for posttraumatic stress disorder (PTSD) are typically small. Given the variation between patients in treatment response, personalization offers a new way to improve treatment outcomes. The aim of this study was to identify predictors of psychotherapy outcome in PTSD and to combine these in...

Zusammenfassung Ziel der Studie Bei der Untersuchung von sozialer Ängstlichkeit haben sich die Fragebögen Liebowitz Social Anxiety Scale (LSAS) und das Social Phobia-Inventory (SPIN) etabliert. Außerdem wird zum Screening sozialer Ängstlichkeit häufig die Subskala Unsicherheit im Sozialkontakt des Brief Symptom Inventory (BSI-53) eingesetzt. Alle d...

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...

The article “Working Towards the Development and Implementation of Precision Mental Healthcare: An Example” written by “Wolfgang Lutz, Brian Schwartz, Juan Martin Gomez Penedo, Kaitlyn Boyle, Anne‑Katharina Deisenhofer”, was originally published Online First without Open Access. After publication in volume 47, issue 5, pages 856–861 the author deci...

Objective: Accumulating research demonstrates the importance of utilizing supportive techniques in psychotherapy; however, little is known about therapeutic processes that are set in motion following the use of supportive techniques. The present study examined the effects of supportive techniques on nonverbal synchrony, both at the sample level and...

No se han encontrado instrumentos breves válidos en Argentina para monitorear sintomatología psicológica en psicoterapia. Este trabajo presenta la adaptación argentina del Hopkins Symptoms Checklist (HSCL-11) y estudia sus propiedades psicométricas. Una muestra de 356 participantes completó la adaptación del HSCL-11 junto con medidas de depresión,...

We read the article “Clinimetric Criteria for Patient-Reported Outcome Measures” with great interest. Highlighting certain test characteristics for patient-reported outcome measures (PROMs) that seem to be neglected in the psychometric literature is a commendable endeavor. We share the authors' intention of supporting clinical practice by providing...

Zusammenfassung. Theoretischer Hintergrund: In der Ausbildung von Psychotherapeutinnen konnte bereits ein subjektiver Kompetenzgewinn durch die Arbeit mit Simulationspatientinnen (SP) belegt werden. Fragestellung: Neben der Replikation dieser Befunde, welche auf Selbstberichten basieren, untersuchte vorliegende Studie die objektive Behandlungsinteg...

In dem Gesetz zur Reform der Psychotherapeutenausbildung vom 15. November 2019 wird eine verstärkte Qualitätssicherung in der ambulanten Psychotherapie festgelegt . Dass dies ebenfalls ein Anliegen der Patient/innen ist, zeigen unter anderem ein Interview mit Jürgen Matzat, Patientenvertreter im Unterausschuss Psychotherapie des Gemeinsame Bundesau...

Objective: We aimed to develop and test an algorithm for individual patient predictions of problem coping experiences (PCE) (i.e., patients' understanding and ability to deal with their problems) effects in cognitive-behavioral therapy. Method: In an outpatient sample with a variety of diagnoses (n=1010), we conducted Dynamic Structural Equation M...

Objective: Despite evidence showing that systematic outcome monitoring can prevent treatment failure, the practical conditions that allow for implementation are seldom met in naturalistic psychological services. In the context of limited time and resources, session-by-session evaluation is rare in most clinical settings. This study aimed to valida...

Objective: Thus far, most applications in precision mental health have not been evaluated prospectively. This article presents the results of a prospective randomized-controlled trial investigating the effects of a digital decision support and feedback system, which includes two components of patient-specific recommendations: (a) a clinical strate...

Background Changes during psychotherapy often include sudden symptom improvements, called sudden gains (SGs), which have been identified as being superior to gradual symptom change with regard to treatment success. This study investigates the role of therapists in initiating and/or consolidating SGs. Methods The analyses are based on a sample of p...

The current study employed machine learning to investigate whether the inclusion of observer-rated therapist interventions and skills in early sessions of psychotherapy improved dropout prediction beyond intake assessments. Patients were treated by post-graduate clinicians at a university outpatient clinic. Psychometric instruments were assessed at...

Objective: The effectiveness of Imagery Rescripting (IR) has been demonstrated in the treatment of various psychological disorders, but the mechanisms underlying it remain unclear. While current investigations predominantly refer to memory processes, physiological processes have received less attention. The main aim of this study is to test whether...

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...

Objective: There is little evidence-based knowledge of how psychotherapists should handle both sudden gains and more gradual session-by-session changes, either in general or in individuals suffering from generalized anxiety disorder. Methods: Using an ABAB crossed-therapist randomized clinical implementation trial design (N = 80 patients and 20...

In psychotherapy research, the measurement of treatment processes and outcome are predominantly based on self-reports. However, given new technological developments, other potential sources can be considered to improve measurements. In a feasibility study, we examined whether Ecological Momentary Assessments (EMA) using digital phenotyping (stress...

Background Psychology is at the beginning of a cooperative revolution. Traditionally, psychological research has been conducted by individual labs, limiting its scope in clinical samples and promoting replication problems. Large-scale collaborations create new opportunities for highly powered studies in this resource-intensive research area. To pre...

Zusammenfassung Einleitung Sexuelle Funktionsstörungen gelten als häufig. Gleichzeitig fehlen epidemiologische Daten zur Behandlungsprävalenz sexueller Funktionsstörungen in der ambulanten Psychotherapie. Im Rahmen eines Projekts zur Koordination der Datenerhebung an den deutschen Hochschulambulanzen für Psychotherapie wird erstmals eine Schätzung...

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...

Background Although a wide body of research links depression to interpersonal deficits, Cognitive-Behavioral Therapy (CBT), considered the gold standard in the treatment of this condition, has not been developed to specifically address interpersonal difficulties. However, cognitive changes on a relational level occurring during CBT might play an im...

Understanding and, by extension, being able to critically assess a variety of research methodologies is crucial to the advancement of clinical psychology as a science. We present here the foundational methodologies used in clinical psychological science, including more contemporary approaches (as well as the debates that often surround them). Topic...

Objective: Both good therapeutic bond as well as extra-therapeutic social support seem to enhance treatment outcomes. Some features of the therapeutic bond are similar to experiences in extra-therapeutic relationships (e.g., feelings of trust or belongingness). Patients with a lack of social support might benefit particularly from a good therapeuti...

Background: Psychology is at the beginning of a cooperative revolution. Traditionally, psychological research has been conducted by individual labs, limiting its scope in clinical samples and promoting replication problems. Large-scale collaborations create new opportunities for highly powered studies in this resource-intensive research area. To pr...

In den letzten Jahren gibt es einen Wandel im Bereich theoretischer Neuentwicklungen in der Psychotherapie als auch in der Psychotherapieforschung zu verzeichnen. Neben der Untersuchung und Integration einer Vielzahl von gut bewährten störungsspezifischen Therapiekonzepten in die psychotherapeutische Praxis und Ausbildung von Psychotherapeutinnen u...

Background: Sexual dysfunctions are considered to be common. However, there is a lack of epidemiological data on the prevalence of sexual dysfunction in outpatient psychotherapy. For the first time, a robust estimate is possible based on coordinated data collection at the German university outpatient clinics for psychotherapy.Method: 16 university...

Leonard Bickman’s (2020) Festschrift paper in the special issue “The Future of Children’s Mental Health Services” on improving mental health services is an impressive reflection of his career, highlighting his major insights and the development of mental health services research as a whole. Five major difficulties in this field’s current research a...

Background The study examined therapist effects in the psychotherapy of social anxiety disorder using three methodological approaches: 1) variances of random effects, 2) effects of sociodemographic therapist variables and 3) disaggregation of therapeutic relationship and movement synchrony into between-therapist and within-therapist components.Mate...

Objective: Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-se...

In the present study, sessions prior to sudden gains, sudden losses, and neutral control sessions were examined regarding the processes of change resource activation, problem actuation and therapeutic alliance. With respect to these change processes, we examined whether pregain, preloss, and neutral sessions are distinguishable by particular patter...

Objective One of the promises of the experience sampling methodology (ESM) is that a statistical analysis of an individual's emotions, cognitions and behaviors in everyday-life could be used to identify relevant treatment targets. A requisite for clinical implementation is that outcomes of such person-specific time-series analyses are not wholly co...

The examination of nonverbal synchrony has become a promising line of psychotherapy research. Although several studies have found between‐dyad associations between nonverbal synchrony and multidimensional outcomes, the findings remain heterogeneous and within‐dyad effects remain to be investigated. The present study examines within and between effe...

Early change is an increasing area of investigation in psychotherapy research. In this study, we analyzed patterns of early change in interpersonal problems and their relationship to nonverbal synchrony and multiple outcome measures for the first time. We used growth mixture modeling to identify different latent classes of early change in interpers...

Objective: The study explored the presence of different patterns of change in a sample of patients who received cognitive therapy for depression sequentially in two different formats: group and individual. Our hypothesis was that patients' baseline characteristics (e.g., symptom severity, self-esteem) would discriminate patterns of response to grou...

This study tested the hypothesis that chronic depression (CD) is more similar to depression with multiple prior episodes (ME) than to depression with few prior episodes (FE). Data from participants (n = 1013) with mild to moderate depressive symptoms (Patient Health Questionnaire [PHQ-9] score 5 – 14) who took part in a randomized control trial of...

Objective: This study aims at developing a treatment selection algorithm using a combination of machine learning and statistical inference to recommend patients’ optimal treatment based on their pre-treatment characteristics. Methods: A disorder-heterogeneous, naturalistic sample of N = 1,379 outpatients treated with either cognitive behavioral the...

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...

(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)....