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The Dose-Effect Relationship in Psychotherapy
Abstract
Applied probit analysis to 15 sets of data to specify the relationship between length of treatment and patient benefit. Data were based on more than 2,400 patients, covering a period of over 30 yrs of research. The probit model resulted in a good fit to these data, and the results were consistent across the studies, allowing for a meta-analytic pooling that provided estimates of the expected benefits of specific "doses" of psychotherapy. Analysis indicated that by 8 sessions approximately 50% of patients were measurably improved, and approximately 75% were improved by 26 sessions. Further analyses showed differential responsiveness for different diagnostic groups and for different outcome criteria. Findings hold promise for establishing empirical guidelines for peer review and 3rd-party financial support of psychotherapy. (30 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Several studies have shown that psychological interventions are effective for people suffering from various psychological problems, such as PTSD, stress, anger, and depression [18,19]. Howard et al. [20] argued that psychotherapy was more significant than spontaneous recovery, based on the results of a meta-analysis of the effects of psychotherapy on 2400 clients over a 30 year study period. On the other hand, while Cuijpers et al. [21] did not deny the effectiveness of psychotherapy, they reported that the effectiveness of psychotherapy was somewhat exaggerated. ...
... Second, is individual psychotherapy effective for survivors of humidifier disinfectants? According to the results of previous research [18][19][20][21], we assume that individual psychotherapy has a considerable impact in relieving psychological symptoms. Third, which survivor groups benefited the most from psychotherapy? ...
This study aimed to examine group differences in the survivors of humidifier damage and the effect of individual psychotherapy on the psychological symptoms of the survivor groups, using the single group pre–post study design. A series of Wilcoxon–Mann–Whitney tests were conducted to investigate the level of psychological problems before and after psychotherapy, as well as the main and interaction effects of demographic characteristics and adaptive functioning on the treatment effects in 69 humidifier disinfectant survivors. The results demonstrated significant differences in problems with socioeconomic status (SES), life functioning, friendships, family relationships, and job adjustment in the survivor groups. Groups with high SES, low life functioning, and poor friend relationships had more problem behaviors than other groups. Problem behaviors related to friendship levels were different before and after psychotherapy. After psychotherapy, individuals with limited social connections exhibited a greater decrease in problem behaviors compared to those with strong friendships. This paper extends the international literature on the long-term consequences of environmental health hazards and the importance of tailored mental health interventions.
... Predicting the pattern of change in psychotherapy has important theoretical, clinical, and health policy implications, including recommending the optimal therapeutic dose. Typically, psychotherapy follows a negatively accelerated log-linear pattern, with the greatest changes occurring early on (Howard et al., 1986;Stulz et al., 2013). Nordmo et al. (2020) analysis of naturalistic data on open-ended dynamic therapy revealed a linear relationship, showing a steady improvement throughout treatment. ...
... Still, the measurements were not frequent enough to detect this. The change patterns of the observed groups were not linear, as was found in openended dynamic psychotherapy in a community sample (Nordmo et al., 2020), and did not follow a log-linear change pattern either, as the dose-response model would predict (Howard et al., 1986). ...
Objectives:
This study aimed to identify and describe trajectories of change in distress among highly challenging patients who had received long and intensive psychoanalytic psychotherapy.
Methods:
The longitudinal version of the K-means algorithm was applied to the outcome measures data of 74 patients treated in four public mental health centers. The patients were measured five times at 6-month intervals for three outcome measures.
Results:
For the OQ45 and Symptom Checklist-90, one trajectory was marked by a lower initial distress level. In this trajectory, the improvement occurred in the first half of the measurements, with a plateau thereafter. A second trajectory was characterized by higher initial severity and an improvement, mainly in the second part of the measurements. For the Beck Depression Inventory, one trajectory was marked by lower initial distress. In this group, the improvement occurred throughout the entire period. The remaining patients were characterized by higher initial distress and a decreased level of distress in the last part of treatment. They began to improve only during the third year of therapy.
Conclusion:
The response to treatment is not uniform in long-term treatment for highly challenging patients. A significant number of patients require a longer period of therapy to ignite improvement.
... Because of the relatively lengthy psychological treatments delivered in tertiary care, understanding the dose-response relationship in this context is of clinical and empirical interest (i.e., where the "dose" refers to the number of sessions and "response" refers to the clinical outcome; Howard et al., 1986). The dose-response relationship during routine psychological interventions is often found to be curvilinear, with most of the changes observed during earlier stages of treatment (see review by Robinson et al., 2020). ...
... In particular, this review highlighted the absence of tertiary level care evidence. The impact of patient complexity on the dose-response effect is supported by studies demonstrating that patients with chronic and characterological symptoms require longer treatments to reach comparable response rates (Howard et al., 1986) and that interpersonal problem resolution lags behind symptom improvement (Kopta et al., 1994). In a rare examination of the dose-response effect in long-term and open-ended psychotherapy for patients with severe psychopathology, Nordmo et al. (2021) reported that the degree of improvement was linearly associated with treatment duration and moderated by intake severity (less severe cases improved sooner). ...
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 Questionnaire-45 (OQ-45) over a 10-year period in a tertiary care psychotherapy service. The modalities evaluated were cognitive-behavioural, cognitive-analytic, and psychoanalytic psychotherapies.
Methods:
Effectiveness was calculated at the service level and for each modality using pre-post-effect sizes and recovery rates. Benchmarking included a random-effects meta-analysis. Trajectories of change for each modality were examined using growth curve models.
Results:
Baseline distress on the OQ-45 was higher than comparative norms (M = 102.57, SD = 22.79, N = 364). The average number of sessions was 48.68 (SD = 42.14, range = 5-335). There was a moderate pre-post-treatment effect (d = .46, 95% CI = .37-.55) which was lower than available benchmarks. The modalities differed in duration but were largely equivalent in terms of outcome. The reliable improvement rate was 29.95%, and the recovery rate was 10.16%, and change over time was best explained using a nonlinear (cubic) time trend.
Conclusions:
The elevated distress at baseline appears to create the conditions for relatively lengthy interventions and attenuated clinical outcomes. Suggestions are made regarding the clinical role, function, and evaluation of tertiary care psychotherapy services.
... También se destaca que la calidad de las actividades propuestas en los programas de DP influye para que los usuarios permanezcan en rehabilitación por más tiempo, haciendo más probable que completen intervenciones de 24 semanas, además de que influyen en la reducción del consumo de alcohol o de drogas durente dos, cinco y hasta dieciséis años de seguimiento (McKellar et al., 2003;Moos y Moos, 2007;Ritsher et al., 2002). Lo dicho anteriormente significa que la duración de este tipo de tratamiento constituye un predictor significativo, llegándose a estimar que la mitad de los pacientes requieren de trece a dieciocho sesiones para alcanzar un resultado clínico excelente (Hansen et al., 2002;Howard et al., 1986). ...
Los factores relacionados con el tratamiento terapéutico constituyen importantes predictores asociados a la prevención de recaídas durante la recuperación de las drogodependencias. Sin embargo, aún es necesario investigar por qué algunos de los elementos propios del periodo de rehabilitación son lo suficientemente efectivos para elevar significativamente las probabilidades de remisión de los trastornos por abuso de sustancias. Por ello, el objetivo del presente estudio fue analizar la manera en que la interrelación de las variables predictoras agrupadas en el dominio del tratamiento influyen o contrarrestan el retorno al consumo de drogas en usuarios drogodependientes. Para ello, se llevó a cabo una revisión sistemática en las bases de datos EBSCO, Scopus y Science Direct que abarcó el período de 2011 a 2020. Después de aplicar los criterios de inclusión y exclusión, establecidos a partir de la estrategia PICOS, se seleccionó un total de ocho artículos, de los cuales la mayoría tenían diseños aleatorios controlados, con cifras de participantes superiores a mil usuarios, seguimientos longitudinales de más de doce meses y procedimientos estadísticos multivariados. Las principales variables predictoras identificadas fueron la calidad de los programas de autoayuda de doce pasos, el apoyo de pares, los tratamientos grupales, la atención plena, la duración del tratamiento y el tipo de servicios (ambulatorios o residenciales). Los estudios que denotaron tener una mayor consistencia destacan la importancia de la participación comprometida en grupos de autoayuda, la calidad de las actividades propuestas en los programas de doce pasos y el apoyo de pares como componentes clave para prevenir recaídas durante la recuperación de las drogodependencias.
... TA refers to the collaborative relationship between patient and therapist aimed at achieving therapeutic goals (Bordin, 1979). It has been shown to be a robust indicator of clinical outcomes in various treatments and populations (Coryell, 1995;Flückiger et al., 2018;Horvath et al., 2011;Howard et al., 1986;Lambert & Barley, 2001;Raue & Goldfried, 1994). The exploration of eHealth TA (ETA) has grown in recent years, with studies indicating the formation of TA in human-guided as well as unguided EHIs (Barazzone et al., 2012;Berger, 2017;D'Alfonso et al., 2020;Hollis et al., 2018;Lopez et al., 2019;Ormrod et al., 2010). ...
Most measures designed to assess eHealth therapeutic alliance (ETA) derive from conventional factors of therapeutic alliance. This study examined whether integrating subscales developed directly to capture therapeutic alliance facets that are unique to the digital space contribute above conventional factors to understanding ETA. The eHealth Therapeutic Alliance Inventory (ETAI) was developed based on a review of face-to-face TA measures combined with new items related to ETA uniquely. Following development, a panel of psychologists who are also eHealth experts, evaluated ETAI’s content validity prior to testing. A sample consisted of 273 adults in the USA, participating in 6-month mobile alcohol reduction intervention who completed ETAI at the end of the intervention. Factor structure was examined using exploratory factor analysis; internal reliability using Cronbach’s α; regressions were calculated assessing items’ contribution to explaining two clinical-related-outcomes: participant experience of positive change, and commitment to change towards the future. Two-factor solution was found with conventional items loading on the first factor and items representing application-induced accountability, on the second, resulting in a 10-item scale with adequate internal consistency for both factors (α = 0.93; α = 0.83, respectively). Both factors had a unique contribution to explaining “experiencing positive change” (factor 1: β = 0.27, p < 0.001; factor 2: β = 0.30, p < 0.001); only factor 2 had a unique contribution to explaining “commitment to change” (factor 2: β = 0.39, p < 0.001). Unique scales capturing ETA may contribute to our understanding of user engagement with digital tools and to explaining clinical-related outcomes.
... Estudios han señalado que la asociación entre sesiones de tratamiento como dosis, y la respuesta a éste, reporta variaciones durante la totalidad del proceso terapéutico, aunque los mecanismos que subyacen a estos cambios no han sido aun completamente dilucidados Castonguay et al., 2013). Howard et al. (1986) sugirieron que el cambio en psicoterapia es el resultado de una curva de dosis-efecto obtenida al asociar el número de sesiones de terapia recibidas (dosis) y la mejoría sintomática (efecto). Ellos señalan que la curva resultante sigue una trayectoria de aceleración negativa. ...
Antecedentes:
identificar subgrupos de pacientes que demuestren diferentes trayectorias de cambio terapéutico durante psicoterapia en contextos realistas es relevante para el desarrollo de procesos terapéuticos personalizados y efectivos.
Objetivos:
El presente estudio tuvo como objetivos (a) identificar trayectorias de cambios terapéutico en pacientes chilenos (b) explorar variables que puedan predecir la probabilidad de pertenecer a ciertas trayectorias y (c) examinar si estas diferentes trayectorias desembocan en distintos resultados terapéuticos.
Método:
se llevaron a cabo análisis de modelos de crecimientos mixto (Growth Mixture Modeling - GMM) y regresiones logísticas multinominales en una muestra de 400 pacientes chilenos recibiendo psicoterapia en un centro de salud mental privado.
Resultados:
se identificaron tres trayectorias de cambio terapéutico (a) disfunción inicial moderada con leve deterioro, (b) disfunción inicial leve con cambio favorable y (c) disfunción inicial severa con rápido cambio favorable. La edad de los pacientes fue considerada un factor predictor de trayectoria significativa, sugiriendo una peor prognosis para pacientes de mayor edad. Además, todas las trayectorias fueron predictoras del resultado terapéutico.
Conclusiones:
estos resultados pueden ser utilizados para desarrollar intervenciones enfocadas en el paciente, basadas en las trayectorias de cambio que exhiban.
... The "dose-response" model of psychotherapy outlines a relationship whereby patients improve in psychotherapy with each additional dose (session), at a negatively accelerating rate (Howard et al., 1986). Under the assumptions of dose-response, therapy length drives patients' improvement and the rate of symptom change is not expected to vary along with the total number of completed sessions. ...
Objective:
The dose-response model of change in psychotherapy posits that each session of therapy is incrementally beneficial across patients. The contrasting good-enough level model suggests that patients improve at different rates in therapy and discontinue treatment when they are satisfied with their improvement. Support for each theory has been mixed, and many prior studies have relied on samples of patients receiving unstructured treatment approaches. We conducted this study to compare these two theories across two manualized treatments for posttraumatic stress disorder (PTSD).
Method:
Two hundred eighty-four female veterans and military service members with PTSD (Mage = 44.79; 54.6% White non-Hispanic, 6.7% Black non-Hispanic, 37% other) were randomized to receive 10 sessions of prolonged exposure (PE), a trauma-focused therapy, or present-centered therapy (PCT), a non-trauma-focused therapy. Participants completed the PTSD Checklist (PCL) at even-numbered treatment sessions, and the timing of dropout/treatment completion was monitored.
Results:
The point of highest risk for dropout differed between the treatments, with risk in PE corresponding to the beginning of imaginal exposures. In the PE condition, but not in PCT, a higher number of sessions completed increased the likelihood of achieving reliable clinically significant improvement. Across treatments, the rate of change in PTSD symptoms did not differ according to the number of sessions completed (b = 0.06, p = .687).
Conclusions:
Findings support the dose-response model of change in psychotherapy. There were notable differences in dropout across the treatment conditions, including rates, timing, and implications for outcomes. These differences likely reflect differences in content between the protocols. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... The relationship between dose and effect in psychotherapy has been studied with mixed results in noncontrolled studies [5,7]. While several non-controlled studies indicate that there is a linear or negatively accelerating relationship between number of psychotherapy sessions and outcome for most mental health disorders [8,9], these findings have been criticized on methodological grounds [10]. ...
Background
The optimal psychotherapy duration for mental health disorders is unclear. Our aim was to assess the beneficial and harmful effects of shorter- versus longer-term psychotherapy for adult mental health disorders.
Method
We searched relevant databases and websites for published and unpublished randomised clinical trials assessing different durations of the same psychotherapy type before June 27, 2022. Our methodology was based on Cochrane and an eight-step procedure. Primary outcomes were quality of life, serious adverse events, and symptom severity. Secondary outcomes were suicide or suicide-attempts, self-harm, and level of functioning.
Results
We included 19 trials randomising 3,447 participants. All trials were at high risk of bias. Three single trials met the required information size needed to confirm or reject realistic intervention effects. One single trial showed no evidence of a difference between 6 versus 12 months dialectical behavioral therapy for borderline personality when assessing quality of life, symptom severity, and level of functioning. One single trial showed evidence of a beneficial effect of adding booster sessions to 8 and 12 weeks of internet-based cognitive behavioral therapy for depression and anxiety when assessing symptom severity and level of functioning. One single trial showed no evidence of a difference between 20 weeks versus 3 years of psychodynamic psychotherapy for mood- or anxiety disorders when assessing symptom severity and level of functioning. It was only possible to conduct two pre-planned meta-analyses. Meta-analysis showed no evidence of a difference between shorter- and longer-term cognitive behavioural therapy for anxiety disorders on anxiety symptoms at end of treatment (SMD: 0.08; 95% CI: -0.47 to 0.63; p = 0.77; I² = 73%; four trials; very low certainty). Meta-analysis showed no evidence of a difference between shorter and longer-term psychodynamic psychotherapy for mood- and anxiety disorders on level of functioning (SMD 0.16; 95% CI -0.08 to 0.40; p = 0.20; I² = 21%; two trials; very low certainty).
Conclusions
The evidence for shorter versus longer-term psychotherapy for adult mental health disorders is currently unclear. We only identified 19 randomised clinical trials. More trials at low risk of bias and at low risk of random errors assessing participants at different levels of psychopathological severity are urgently needed.
Systematic review registration
PROSPERO CRD42019128535.
... Therefore, processual models attempt to represent change as a process that unfolds over time during psychotherapy without theorizing stages or phases. One of the first processual models of change was the dose-effect one (DE; Howard et al., 1986). DE assumes a negatively accelerated relationship between the number of sessions (i.e., the dose) and the client's rate of change (i.e., the effect). ...
This overview addresses for whom and under what conditions psychotherapy produces change, the course of change over sessions, and why change happens. Specifically, the most confirmed moderators are pretreatment symptoms level, readiness for change, assertiveness, agency, defense maturity, quality of object relationships, mentalization, and interpersonal functioning. Regarding the course of change, processual models better describe change than stage ones, capturing its nonlinear and time-embedded nature. Moreover, trajectories of change describe different classes of change by clients (i.e., from three to five) and might be helpful feedback for clinicians. Furthermore, the most confirmed change mechanisms in literature for individual psychotherapy are insight, affective awareness, reflective functioning, externalizing difficulties, self-talk, coping, emotion regulation, the reappraisal of threat, fear extinction, change of interpersonal cognitions/avoidance, compensatory skills, mood regulation expectancies, diet habits, and self-efficacy. Conversely, emotional closeness, couple satisfaction, blamer softening, family functioning, and parental competence are confirmed mechanisms for couple/ family psychotherapy. Finally, transversal mechanisms common to many approaches should not be considered equal to common factors, such as alliance, emotional regulation, and insight
... [13][14][15] As 'dose', different factors can be considered, for example, total number of sessions, number of sessions per week or the session duration. Howard and colleagues 16 were one of the first to look at the number of sessions needed to reach symptom recovery by calculating a probit model (dose-response model). After eight sessions, 50% of the patients showed symptom improvement, whereas 75% of the patients improved after 26 sessions. ...
Introduction
The effectiveness of psychotherapy in depression is subject of an ongoing debate. The mechanisms of change are still underexplored. Research tries to find influencing factors fostering the effect of psychotherapy. In that context, the dose–response relationship should receive more attention. Increasing the frequency from one to two sessions per week seems to be a promising start. Moreover, the concept of expectations and its influence in depression can be another auspicious approach. Dysfunctional expectations and the lack of their modification are central in symptom maintenance. Expectation focused psychological interventions (EFPI) have been investigated, primarily in the field of depression. The aim of this study is to compare cognitive behavioural therapy (CBT) once a week with an intensified version of CBT (two times a week) in depression as well as to include a third proof-of-principle intervention group receiving a condensed expectation focused CBT.
Methods and analysis
Participants are recruited through an outpatient clinic in Germany. A current major depressive episode, diagnosed via structured clinical interviews should present as the main diagnosis. The planned randomised-controlled trial will allow comparisons between the following treatment conditions: CBT (one session/week), condensed CBT (two sessions/week) and EFPI (two sessions/week). All treatment arms include a total dose of 24 sessions. Depression severity applies as the outcome variable (Beck Depression Inventory II, Montgomery Asberg Depression Rating Scale). A sample size of n=150 is intended.
Ethics and dissemination
The local ethics committee of the Department of Psychology, Philipps-University Marburg approved the study (reference number 2020-68 v). The final research article including the study results is intended to be published in international peer-reviewed journals.
Trial registration number
German Clinical Trials Registry (DRKS00023203).
... Sudden gains, clinically relevant decreases in symptoms between consecutive treatment sessions, have consistently predicted better treatment outcomes regardless of when they occur in treatment (Tang & DeRubeis, 1999;Shalom & Aderka, 2020). Early investigations into optimized treatment length examined the relationship between the quantity or concentration (i.e., "dose") of treatment and the subsequent probability of clinical improvement (Howard et al., 1986). In these studies, clinical improvement is typically defined as a statistically reliable reduction in psychiatric symptoms using Jacobson and Truax's (1991) definition of reliable and clinically significant improvement (RCSI). ...
Objective
This study explores whether early change on a putative mechanism maintaining symptoms can serve as a proximal indicator of response to prompt discontinuation.
Method
Patients (N = 70; Mage = 33.74, 67% female, 74% white) with heterogeneous anxiety and depressive disorders completed a sequential multiple assignment randomized trial (SMART). Patients received 6 sessions of skill modules from the Unified Protocol and then underwent a second-stage randomization to either receive the remaining 6 sessions (Full duration) or discontinue treatment (Brief duration). All participants completed weekly self-report measures of anxiety and depressive symptoms and distress aversion for the full 12-week treatment window. We used structural equation modeling to test (1) if distress aversion demonstrated significant variability during the first-stage randomization and (2) if distress aversion during the first-stage randomization predicted second-stage changes in anxiety and depression.
Results
Participants demonstrated significant variability in first-stage distress aversion. Latent distress aversion slopes significantly predicted latent second-stage anxiety slopes, whereas latent distress aversion intercepts significantly predicted latent second-stage depression slopes.
Conclusions
These results suggest that early mechanism engagement may have potential as a trigger to prompt personalized termination. Shorter courses of care may reduce patient costs and increase the mental health service system's capacity.
... Sudden gains, clinically relevant decreases in symptoms between consecutive treatment sessions, have consistently predicted better treatment outcomes regardless of when they occur in treatment (Tang & DeRubeis, 1999;Shalom & Aderka, 2020). Early investigations into optimized treatment length examined the relationship between the quantity or concentration (i.e., "dose") of treatment and the subsequent probability of clinical improvement (Howard et al., 1986). In these studies, clinical improvement is typically defined as a statistically reliable reduction in psychiatric symptoms using Jacobson and Truax's (1991) definition of reliable and clinically significant improvement (RCSI). ...
Objective: This study explores whether early change on a putative mechanism maintaining symptoms can serve a proximal indicator of response to prompt discontinuation. Method: Participants (N = 70) with heterogeneous anxiety and depressive disorders were enrolled in a pilot sequential multiple assignment randomized trial (SMART). Patients received 6 sessions of skill modules from the Unified Protocol and then underwent a second-stage randomization to either receive the remaining 6 sessions (Full duration) or discontinue treatment (Brief duration). All participants completed weekly self-report measures of anxiety and depressive symptoms (Overall Anxiety Severity and Interference Scale; Overall Depression Severity and Interference Scale) and distress aversion (Multidimensional Experiential Avoidance Questionnaire) for the full treatment window (i.e., 12 weeks). We used structural equation modeling to test (1) if distress aversion demonstrated significant variability during the first-stage randomization and (2) if distress aversion during the first-stage randomization predicted second-stage changes in anxiety and depression. Results: Participants demonstrated significant variability in first-stage distress aversion. Latent distress aversion slopes significantly predicted latent second-stage anxiety slopes, whereas latent distress aversion intercepts significantly predicted latent second-stage depression slopes. Conclusions: These results suggest that it may be possible to use early mechanism engagement as a trigger that prompts personalized termination. Shorter courses of care have the potential to reduce patient costs and increase the mental health service system’s capacity.
... Specifically, the length of the treatment was reported to be a crucial issue: more positive outcomes were indeed observed as the number of sessions increased (Catarino et al., 2018). This result might not be surprising and it mirrors the overall evidence of a positive relationship between the length of face-to-face interventions and the treatment effectiveness (Howard, Kopta, Krause, & Orlinsky, 1986;Knekt et al., 2008;Knekt, Lindfors, Sares-Jäske, Virtala, & Härkänen, 2013;Knekt et al., 2016;Lindfors, Knekt, Heinonen, Härkänen, & Virtala, 2015). ...
... The moderate-severe plateau class may also represent patients who would benefit from more treatment, although some 'nonresponders' would probably not recover even after a very high number of sessions (Howard, Kopta, Krause, & Orlinsky, 1986). Notably, the frequency of onward referrals in this class suggested the presence of co-occurring problems that required specialist services. ...
Background:
There is substantial variation in patient symptoms following psychological therapy for depression and anxiety. However, reliance on endpoint outcomes ignores additional interindividual variation during therapy. Knowing a patient's likely symptom trajectories could guide clinical decisions. We aimed to identify latent classes of patients with similar symptom trajectories over the course of psychological therapy and explore associations between baseline variables and trajectory class.
Methods:
Patients received high-intensity psychological treatment for common mental health problems at National Health Service Improving Access to Psychological Therapies services in South London (N = 16 258). To identify trajectories, we performed growth mixture modelling of depression and anxiety symptoms over 11 sessions. We then ran multinomial regressions to identify baseline variables associated with trajectory class membership.
Results:
Trajectories of depression and anxiety symptoms were highly similar and best modelled by four classes. Three classes started with moderate-severe symptoms and showed (1) no change, (2) gradual improvement, and (3) fast improvement. A final class (4) showed initially mild symptoms and minimal improvement. Within the moderate-severe baseline symptom classes, patients in the two showing improvement as opposed to no change tended not to be prescribed psychotropic medication or report a disability and were in employment. Patients showing fast improvement additionally reported lower baseline functional impairment on average.
Conclusions:
Multiple trajectory classes of depression and anxiety symptoms were associated with baseline characteristics. Identifying the most likely trajectory for a patient at the start of treatment could inform decisions about the suitability and continuation of therapy, ultimately improving patient outcomes.
Objective
Knowledge on predictors for treatment response to psychotherapy in binge‐eating disorder (BED) is mixed and not yet available for increasingly popular neurofeedback (NF) treatment targeting self‐regulation of aberrant brain activity. This study examined eating disorder‐ and psychopathology‐related predictors for NF treatment success in BED.
Method
Patients with BED ( N = 78) were randomized to 12 sessions of real‐time functional near‐infrared spectroscopy (rtfNIRS)‐NF, targeting individual prefrontal cortex signal up‐regulation, electroencephalography (EEG)‐NF, targeting down‐regulation of fronto‐central beta activity, or waitlist (WL). The few studies assessing predictors for clinical outcomes after NF and evidenced predictors for psychotherapy guided the selection of baseline eating disorder‐related predictors, including objective binge‐eating (OBE) frequency, eating disorder psychopathology (EDP), food cravings, and body mass index (BMI), and general psychopathology‐related predictors, including depressive and anxiety symptoms, impulsivity, emotion dysregulation, and self‐efficacy. These questionnaire‐based or objectively assessed (BMI) predictors were regressed on outcomes OBE frequency and EDP as key features of BED at post‐treatment (t1) and 6‐month follow‐up (t2) in preregistered generalized mixed models ( https://osf.io/4aktp ).
Results
Higher EDP, food cravings, and BMI predicted worse outcomes across all groups at t1 and t2. General psychopathology‐related predictors did not predict outcomes at t1 and t2. Explorative analyses indicated that lower OBE frequency and higher self‐efficacy predicted lower OBE frequency, and lower EDP predicted lower EDP after the waiting period in WL.
Discussion
Consistent with findings for psychotherapy, higher eating disorder‐related predictors were associated with higher EDP and OBE frequency. The specificity of psychopathological predictors for NF treatment success warrants further examination.
Public Significance
This exploratory study firstly assessed eating disorder‐ and psychopathology‐related predictors for neurofeedback treatment outcome in binge‐eating disorder and overweight. Findings showed an association between higher eating disorder symptoms and worse neurofeedback outcomes, indicating special needs to be considered in neurofeedback treatment for patients with a higher binge‐eating disorder symptom burden. In general, outcomes and assignment to neurofeedback treatment may be improved upon consideration of baseline psychological variables.
Underlying classes capture differences between patient symptom trajectories during psychological therapy. This has not been explored for one-to-one internet-delivered therapy or functional impairment trajectories. Patients experiencing depression or anxiety received cognitive-behavioural therapy with a therapist using an online chat platform (N = 52,029). Trajectory classes of depression symptoms (PHQ9), anxiety symptoms (GAD7) and functional impairment (WSAS) were investigated using growth mixture modelling. Multinomial regressions tested associations between baseline variables and trajectory class. A four-class trajectory model was selected for each outcome, and these were highly similar. Each outcome showed three classes with initially moderate-severe symptoms or impairment: one demonstrated no change, one gradual improvement and one fast improvement. A fourth class had mild baseline scores and minimal improvement. In the moderate-severe classes, patients in the two with improvement were more likely to be employed and not to have obsessive-compulsive disorder. Fast improvement was likelier than gradual improvement or no change for patients with older age, no disability (e.g., physical, learning), or lower comorbid symptom or impairment scores. Associations with functional impairment classes were more similar to associations with depression classes than anxiety classes. Results were largely consistent with findings from face-to-face therapy. This study is an important step towards personalising therapy in terms of suitability and continuation.
Mindfulness meditation is now practiced broadly in both religious and secular contexts, with numerous studies indicating potential benefits across a range of psychosocial domains. However, despite significant research effort, we still know little about dose-response effects – how frequently or for how longindividuals might need to practice mindfulness meditation to achieve certain practice goals. Increasingly, recommended amounts of practice are becoming shorter while the impact of this reduction on outcomes in unclear. We review and critically appraise the state of knowledge about dose-response effects drawn from empirical investigations, traditional sources, and trends in contemporary teachingand practice. We argue that limitations inherent to the range of doses and analytic approaches used in previous studies reduce our ability to inform the dose-response question. We propose a practical research agenda that prioritizes the question of dose-response, incorporating design features that are optimizedspecifically to understanding the dose-response relationship and how it might vary between outcomes and individuals. Prioritizing the dose-response agenda will allow us to reconcile differences between knowledge sources and enable us to optimize mindfulness offerings based on the individual, their goals, and the context in which they practice.
Background and objectives:
Individuals with hoarding disorder, especially those with problems around acquiring, typically demonstrate a lack of motivation and awareness of their problematic behaviours. Since acquiring behaviours are important targets in interventions for hoarding, effective strategies for increasing motivation in this population are required to enhance the acceptability and efficacy of these interventions.
Methods:
The aim of the current study was to evaluate the ability of a brief online motivational intervention to reduce acquiring in a community sample of high acquirers (N = 159). Participants were randomly assigned to either a motivational interviewing protocol (n = 73) or progressive muscle relaxation control condition (n = 86). Readiness to change and motivation to acquire was measured via self-report, and acquiring behaviour was measured using a modified version of the Preston Acquisition Decision Making Task (to increase ecological validity).
Results:
In both conditions, participants' readiness and motivation to change increased over time. Contrary to hypotheses, the magnitude of this improvement did not significantly differ between conditions. Furthermore, conditions did not perform differently on the behavioural measure of acquiring.
Limitations:
Insufficient dose of the intervention may have precluded any differences being observed between conditions.
Conclusions:
Results underscore the need to better address the problem of lowered motivation in this population.
Content & Focus
The effective length of therapy is a current professional issue affecting counselling psychologists worldwide as the demand on resources increases and the availability of resources decreases. A priority of the World Health Organisation (WHO) Mental Health Gap Action Programme (mhGAP) is to identify strategies to scale up coverage of key interventions in resource constrained settings, promoting the involvement of service users in their own care and treatment. One often neglected area of therapy which may contribute to achieving these objectives is the length of treatment. This paper examines the evidence evaluating the effectiveness of therapeutic interventions of different lengths, and considers the problems associated with clients being prescribed a set number of sessions according to a presenting problem. A relatively recent individualised approach with client input is evaluated, with considerations of how this might fit within counselling psychology philosophy and global mental health policy.
Ideally, the body of counselling psychology knowledge is first informed by the endeavours of research and then applied to a range of normal/distressed populations in different settings. However, an imbalance is evident in that while research still has little impact on counselling practice (e.g. Morrow-Bradley and Elliott, 1986), demands for high quality counselling services are increasing (e.g. in organizational and general practitioner set-tings). This paper argues that there are particular findings from psychotherapy research which can influence counselling practice. And further, that there is a sufficient interface with clinical psychology practice which can benefit counselling psychology, particularly in terms of designing cost-effective counselling services.
Indledningsvist foretages en historisk forankring af den aktuelle tilgang til personlighed og personlighedsforstyrrelse. Herefter tegnes konturerne af en tilknytningsteoretisk funderet forståelse af sværere borderline personlighedsforstyrrelser hos voksne. Disse forstyrrelser er oftest forbundet med ængsteligtambivalent og i nogle tilfælde med ængsteligt-undgående tilknytning, ligesom man ser alvorlige forstyrrelser i affektregulering, mentaliseringsevne og sociale kompetencer. Alt sammen problemområder der bidrager til disse patienters karakteristiske stabile ustabilitet, vanskeligheder i interpersonelle relationer og selvskadende adfærd. Afslutningsvis berøres de terapeutiske implikationer af tilknytningsteoriens væsentlige bidrag til forståelsen af borderline personlighedsforstyrrelsen, herunder inddrages effektundersøgelser af tilknytningsfunderet psykoterapi af borderline personlighedsforstyrrelser
Veterans with PTSD and SUDs often fail to initiate, or prematurely discontinue, mental health treatment in Veteran Affairs Medical Centers (VAMC). While much is known about clinical characteristics and demographic factors impacting treatment engagement in this population, less is known about the role of social factors. This retrospective study examines primary care–based screening assessment and specialty mental healthcare appointment data in a VAMC, to test whether social factors predict treatment initiation and appointment attendance. Findings reveal veterans were more likely to initiate treatment when (a) those with SUDs (n = 235) reported more frequent negative exchanges with others and (b) those with PTSD (n = 2107) reported more perceived support or being partnered. Those with PTSD who were partnered had higher appointment attendance rates. Findings suggest social factors are relevant to treatment initiation among veterans with PTSD and SUDs and that close others may be helpful in facilitating referrals.
This third edition provides a thorough real-world exploration of the scientist-practitioner model, enabling clinical psychology trainees to develop the core competencies required in an increasingly interdisciplinary healthcare environment. The book has been comprehensively revised to reflect shifts towards transdiagnostic practice, co-design principles, and personalized medicine, and features new chapters on low intensity psychological interventions and private practice. Fully updated for the DSM-5 and ICD-11, provides readers with a contemporary account of diagnoses. It covers practical skills such as interviewing, diagnosis, assessment, case formulation, treatment, case management, and process issues with emphasis on the question 'how would a scientist-practitioner think and act?' The book equips trainees to deliver the accountable, efficient, and effective client-centred service demanded of professionals in the modern integrated care setting by demonstrating how an evidence-base can influence every decision of a clinical psychologist. Essential reading for all those enrolled in, or contemplating, postgraduate studies in clinical psychology.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
Charges for medical services of persons covered by the Blue Cross/Blue Shield Federal Employees Program from 1974 through 1978 who were first diagnosed as having one of four chronic diseases in 1975 and within one year began mental health treatment (MHT) were compared with persons who also were first diagnosed as having one of these diseases in 1975 but had no subsequent MHT. In the third year following the diagnosis, those having seven to 20 MHT visits had medical charges $309 lower and those having over 21 MHT visits had medical charges $284 lower than the comparison group. The savings in medical charges over three years of the group having seven to 20 MHT visits were a function of lower use of inpatient services and roughly equaled the cost of 20 MHT visits. Outpatient mental health treatment can be included in a fee-for-service medical care system to improve the quality and appropriateness of care and, if not extensive, may also serve to lower medical care costs.
Answers to the questions of how selection policies and therapeutic practices of psychiatric clinics are related to the personal and social characteristics of patients have long been of interest to psychiatrists, psychologists, hospital administrators, social workers, and ancillary medical personnel. Numerous authors5,8,27,37,41 have published data on limited aspects of these matters, usually relating a single variable, such as social class, to the selection of outpatients for psychotherapy, or to the duration of their treatment. Probably the most comprehensive studies in this general field have been those of Rosenthal and Frank34 and of Jones and Speck19 who have considered the bearing of several factors such as sex, age, education, referral source, income, and diagnosis upon psychotherapeutic outcomes.
The purpose of the present study is to add to the descriptive data in this area, and more specifically to provide preliminary answers to the following
This popular study of "psychological healing"treats topics ranging from religious revivalism and magical healing to contemporary psychotherapies, from the role of the shaman in nonindustrialized societies to the traditional mental hospital. Jerome and Julia Frank (who are father and daughter) contend that these therapies share common elements that improve the "morale"of sufferers. And in combating the "demoralizing meaning"that people attach to their experiences, the authors argue, many therapies are surprisingly similar to rhetoric (the art of persuasion) and to hermeneutics (the study of meanings). Highly acclaimed in previous editions, Persuasion and Healing has been completely revised and expanded. In addition to a broadened exploration of the role of demoralization in illness, this latest edition offers updated information on topics including self-help, family therapy, psychopharmacology, psychotherapy for the mentally ill, and techniques such as primal therapy and bioenergetics. As they explore the power of "healing rhetoric"in these activities, the authors strengthen the ties among the various healing profession.
Investigated the relationship between amount of psychological service offered at a college counseling center and the profit derived therefrom. Ss were 186 students whose progress after at least 2 individual therapy sessions was appraised according to multiple outcome criteria. Results indicate a linear relationship for concrete indicants of change but a nonlinear relationship for self-referent feelings. The latter finding is explained within the context of D. S. Cartwright's failure zone hypothesis. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
60 counselors rated 166 female and 97 male clients seen at a university counseling center over a 3-yr period on 4 outcome measures: psychic distress, interpersonal relations, performance, and overall severity of client's problem. Improvement was studied as a function of the number of weekly sessions for which clients were seen. Results reveal that through 20 sessions there was a strong and consistent (across all outcome measures) positive linear relationship between treatment length and counselor-assessed outcome. After 20 sessions, however, additional counseling was no longer associated with further increases in the rate of improvement. The "failure zone" reported in some earlier studies was not observed. The implications of these findings for clinical practice are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Developed parallel structured-response questionnaires to survey the experiences of patients and therapists in psychotherapeutic sessions. 118 patients and 17 therapists in individual psychotherapy completed these questionnaires after each of from 5-66 consecutive sessions. Analyses of reports of what was talked about during the sessions indicated that (1) patients, focused predominantly on current life concerns and less on inner subjective states; (2) there are 7 major topical themes or clusters; (3) the emergence of these themes is influenced more by intercurrent events than by individual differences; and (4) patients and therapists tended to agree in their perceptions of therapeutic dialogue. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
"96 adults who were neurotic or psychotic rated themselves, and 44 children were rated by their parents on a 5-point scale of improvement from worse to almost completely cured. Reported degrees of improvement were not significantly different for children… and adults… . Both adult and child neurotics reported statistically significant degrees of improvement as the number of hours in therapy increased whereas adult psychotics did not. Adult neurotics showed significant improvement when seen twice a week as compared with those who were seen only once a week, but adult psychotics appeared to be worse when seen twice a week… . It is concluded that limited psychoanalytically-oriented therapy is an effective tool in an outpatient clinic, although some reservations must be made as to its utility with psychotics." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The paper reports the results of analytical psychotherapy on 201 consecutive ambulatory private patients. The amount of therapeutic change depended on the measure used. This varied from 20 per cent. and 40 per cent. to 75 per cent. marked improvement. The illness of a lifetime (average 15 years) had been "cured" in 4 out of 10 cases, the improvement lasting with only a 10 per cent. loss at follow up (20 months). To be effective, therapy must be regular at least once a week, over a minimum period (15-42 sessions in 3-7 months) but not necessarily prolonged or with high density of sessions. Other factors affecting results were discussed.
The statement supported throughout this report is that it is highly improbable that there were operative factors other than therapy itself more crucial in producing the changes reported.
Counselor ratings of success in client-centered psychotherapy for 78 clients were examined in relation to variables of sex, age, student vs. nonstudent status, and length of therapy. It was found that neither sex nor age were significantly related to degree of rated success. Students were somewhat more successful than nonstudents The relation between length of therapy and success rating was complex, with the total sample falling into short-case clients [and] long-case clients. Within each group there was a strong positive relation between number of interviews and success rating. A "failure zone' ranging around 17.5 interviews was interpreted as a period during which potentially long-case clients dropped out of therapy
Conducted a meta-analysis of 143 outcome studies in which 2 or more treatments were compared with a control group. Consistent with previous reviews, the mean of the 1,828 effect size measures obtained from the 414 treated groups approached 1 standard deviation unit, and differences among treatment methods accounted for, at most, 10% of the variance in effect size. The impact of differences between treatment methods was outweighed by the combined effects of other variables, such as the nature of the target problem under treatment, aspects of the measurement methods, and features of the experimental design. Multiple regression analysis suggested that differences between treatments were largely independent of these other factors. Some consistent differences were found between pairs of treatments in the same subsets, with cognitive and certain multimodal behavioral methods yielding favorable results. The practical implications of the conclusions were limited by the predominantly analog nature of the research reviewed and its unrepresentativeness of clinical practice. (50 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Investigated whether therapeutic processes, measured by self-reported attitudes of therapists, are differential or generalized; i.e., whether particular types or all types of patients benefit from a given level of a professed technique. Three therapeutic variables (empathic warmth, directiveness, and uncovering), identified by factor analysis, were studied in interaction with two levels of clinical pathology. A total of 161 patients were seen in psychodynamically oriented individual psychotherapy by 22 therapists. Independent ratings of global improvement were made. Results indicated that high scores on empathic warmth and uncovering appear to be more helpful for patients with neurotic and personality trait disorder diagnoses than for patients with borderline and psychotic diagnoses. Low scores on directiveness seemed to be associated with effectiveness in a more general way (across diagnostic groups). For the most part, reference to therapeutic attitudes as helpful or harmful must take into account the particular diagnostic groups that are being treated.
Assessed psychotherapy outcome for 177 patients who were seen for an average of 31 therapy hours with the Rating Scales for Outcome of Therapy and a Therapist Questionnaire. Results of a components analysis did not support Storrow's rational groupings of the Rating Scales into five dimensions and suggested that two general areas of psychological adjustment underlie the 11 scales. A second components analysis that included both outcome measures supports only in part the contention that when results from diverse outcome measures are factor analyzed, the factors necessarily are associated with method of measurement rather than substantive dimensions of change.
"The major conclusions were: (a) Change in level of personal integration is positively related to case length. Such change has a moderate linear relationship with log case length. (b) Change in level of personal integration is more highly related to case length than change or outcome on other important case variables. (c) Most case variables are slightly related to length of therapy. (d) With respect to actual amount of therapy, change in personal integration may be more important than rated success or other case variables. (e) Case length can be a meaningful variable in the study of therapy." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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