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Validation of the Italian version of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM)

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Unlabelled: The Clinical Outcomes in Routine Evaluation--Outcome Measure (CORE-OM) was translated into Italian and tested in non-clinical (n = 263) and clinical (n = 647) samples. The translation showed good acceptability, internal consistency and convergent validity in both samples. There were large and statistically significant differences between clinical and non-clinical datasets on all scores. The reliable change criteria were similar to those for the UK referential data. Some of the clinically significant change criteria, particularly for the men, were moderately different from the UK cutting points. The Italian version of the CORE-OM showed respectable psychometric parameters. However, it seemed plausible that non-clinical and clinical distributions of self-report scores on psychopathology and functioning measures may differ by language and culture. Key practitioner message: *A good quality Italian translation of the CORE-OM, and hence the GP-CORE, CORE-10 and CORE-5 measures also, is now available for use by practitioners and anyone surveying or exploring general psychological state. The measures can be obtained from CORE-IMS or yourself and practitioners are encouraged to share anonymised data so that good clinical and non-clinical referential databases can be established for Italy.
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Clinical Psychology and Psychotherapy
Clin. Psychol. Psychother. 16, 444–449 (2009)
Published online 21 August 2009 in Wiley InterScience ( DOI: 10.1002/cpp.646
Copyright © 2009 John Wiley & Sons, Ltd.
Validation of the
Italian version of the
Clinical Outcomes in
Routine Evaluation
Outcome Measure
Gaspare Palmieri,1* Chris Evans,2 Vidje Hansen,3,4
Greta Brancaleoni,3 Silvia Ferrari,1 Piero Porcelli,5
Francesco Reitano6 and Marco Rigatelli1
1Casa di Cura Villa Igea, Modena, Italy
2Nottinghamshire Healthcare NHS Trust, Nottingham, UK
3Institute of Clinical Medicine, University of Tromsø
4Psychiatric Department, University Hospital Northern Norway
5Psychosomatic Unit, IRCCS De Bellis Hospital, Bari, Italy
6Psychological Service (Mental Health Department), APSS Trento, Italy
The Clinical Outcomes in Routine Evaluation—Outcome Measure
(CORE-OM) was translated into Italian and tested in non-clinical
(n = 263) and clinical (n = 647) samples. The translation showed good
acceptability, internal consistency and convergent validity in both
samples. There were large and statistically signifi cant differences
between clinical and non-clinical datasets on all scores. The reliable
change criteria were similar to those for the UK referential data. Some
of the clinically signifi cant change criteria, particularly for the men,
were moderately different from the UK cutting points. The Italian
version of the CORE-OM showed respectable psychometric param-
eters. However, it seemed plausible that non-clinical and clinical dis-
tributions of self-report scores on psychopathology and functioning
measures may differ by language and culture. Copyright © 2009 John
Wiley & Sons, Ltd.
Key Practitioner Message:
A good quality Italian translation of the CORE-OM, and hence the
GP-CORE, CORE-10 and CORE-5 measures also, is now available
for use by practitioners and anyone surveying or exploring general
psychological state. The measures can be obtained from CORE-IMS
or yourself and practitioners are encouraged to share anonymised
data so that goodclinical and non-clinical referential databases can
be established for Italy.
* Corresponding author: Dr Gaspare Palmieri, Casa di Cura Villa Igea, via Stradella 73, 41040, Saliceta San Giuliano, Modena,
Validation of CORE-OM 445
Copyright © 2009 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. 16, 444–449 (2009)
DOI: 10.1002/cpp
The Clinical Outcomes in Routine Evaluation–
Outcome Measure (CORE-OM; Evans et al., 2000)
is a 34-item self-report measure, which is widely
used in the UK and shown to be reliable, valid
and acceptable in a range of settings (Barkham
et al., 2002; Evans, Connell, Barkham, Marshall,
& Mellor-Clark, 2003; Shepherd et al., 2005). The
items cover four domains: subjective well-being,
problems/symptoms, life functioning and risk.
These domains are not separate linear factors
but different areas of expression of distress and
dysfunction as shown in (Lyne, Barrett, Evans,
& Barkham, 2006). Higher scores on all domains
indicate more problems by reversing scoring on
eight positively keyed items; total score has been
reported as mean across items completed. More
recently, Connell and Barkham (2007) recommend
multiplying that score by 10 to avoid decimal frac-
tions, we report raw means for comparability with
Evans et al. (2002) (this paper is referred to as ‘the
UK data’). The CORE-OM measure is copyleft, i.e.,
can be reproduced on paper without a fee provided
it is not changed in any way (all CORE measures
are copyleft, see
There is a great need for outcome measures in
Italian psychotherapy services as routine evalua-
tion is not common in Italy and should be imple-
mented (Chiappelli et al., 2007; Gallo & Rucci, 2000;
Lomazzi et al., 1997). The most popular measures
currently used in psychological therapies in Italy
are the Global Assessment of Functioning (GAF)
(Spitzer et al., 1994) and the SCL-90 (Derogatis,
1977), the latter despite the absence of any pub-
lished psychometric data on the Italian version.
The creation and validation of an Italian CORE-
OM could help close gaps between clinical practice
and research in psychological treatments.
The Italian CORE-OM was produced starting with
independent forward translations by seven mental
health professionals and three professional transla-
tors, then all translations were reviewed by a subset
of translators and one of the original authors (CE),
seeking the best translation holding the meaning
of the original version but a comparable informal
style in Italian. The fi nal version and the derived
shortened forms (i.e., the CORE-SFA/SFB, GP-
CORE, CORE-10 and CORE-5) are all available
from the fi rst author and
The non-clinical sample included volunteer
medical students (n = 189) approached by GB at the
end of lectures and invited to take part in a study of
seasonal affective disorder; the response rate was
100%. To extend the sample, GP approached col-
leagues, psychiatric trainees, occupational therapy
students and administrative staff members, with
very few refusals (n = 74). It was assumed that all
would be suffi ciently fl uent in Italian that there
were no exclusion criteria. The clinical sample
included inpatients (n = 68) and outpatients (n =
579) recruited from 17 psychotherapeutic settings
across Italy. The two exclusion criteria were, fi rst,
the reasonable suspicion that the patient could not
read or write Italian fl uently and, second, the clini-
cal judgement that it would be inappropriate to ask
the patient to participate given their current mental
state. There were very few exclusions or refusals.
Analyses largely following those in (Evans
et al., 2002) and assessed: acceptability; internal
consistency (Cronbach, 1951); principal com-
ponent analyses (PCA), to assess and compare
with the UK/English dimensionality; discriminant
validity (assessed by comparing clinical and non-
clinical subjects); and convergent validity against
the Global Severity Index (GSI) of the Hopkins
Symptom Checklist (SCL-90-R) (Derogatis, 1977).
Using the internal reliabilities, and clinical and
non-clinical means and standard deviations, we
calculated criteria for reliable and clinically sig-
nifi cant change (Jacobson & Truax, 1991; Evans,
Margison, & Barkham, 1998). The methods of
classifying change as ‘reliable’ and as ‘clinically
signifi cant’ address individual change and com-
plement analyses of group mean change. Reliable
change is that found only in 5% of cases if change
were simply due to unreliability of measurement.
Clinically signifi cant change is what moves a
person from a score more characteristic of a clini-
cal population to a score more characteristic of a
non-clinical population.
Analyses were conducted in Statistical Package
for the Social Sciences (SPSS), version 14 or R,
version 2.9.0 (R Development Core Team, 2009).
The dataset consisted of data from 263 non-
clinical and 647 clinical participants. Gender was
Keywords: Outcome Measures, CORE-OM, Validation, Transcultural
446 G. Palmieri et al.
Copyright © 2009 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. 16, 444–449 (2009)
DOI: 10.1002/cpp
not given by 8 participants from the clinical dataset
(0.9%) leaving 514 women (57%) and 388 men (43%);
women outnumbered men in both samples (clinical:
n = 443, 69%; non-clinical sample n = 192, 73%).
Age was missing for nine people and ranged
from 15 to 80 years (Mean = 33, SD = 11.6). The
age for the non-clinical participants ranged from
18 to 59 (Mean = 25; SD = 5.8); for the clinical par-
ticipants, it ranged from 15 to 80 (Mean = 36, SD
= 11.9). The difference was highly statistically sig-
nifi cant (t(874) = 19.1, p < 0.0001). Within the non-
clinical sample 212 (81%) completed all the items,
44 (16.7%) omitted item 1, six (2.3%) omitted item
2 and one (0.4%) omitted item 3 (i.e., all returns
were usable if prorating up to the usual maximum
of three missing items). In the clinical sample, 623
(96%) of returns were complete and the missing
item counts were: one item only (n = 10, 1.5%),
two items (n = 8, 1.2%), three items (n = 5, 0.8%)
and four items (n = 1, 0.2%) (i.e., 99.8% usable).
Internal consistency did not differ signifi cantly
between clinical and non-clinical samples and all
domains showed α > 0.7 with α > 0.9 for the total
score as shown in Table 1 with comparisons with
the original UK parameters.
Spearman rho correlations with the GSI in a
clinical sample of 49 inpatients ranged from 0.79
(Well-being) to 0.87 (Symptoms), somewhat stron-
ger than the correlations in the UK data between
the CORE-OM scores and the BSI, the most similar
measure to the SCL and the GSI scores.
The correlations between age and any of the
CORE-OM scores were very small and non-
signifi cant (largest rho = 0.05 with risk in the clini-
cal sample, p = 0.22). Gender effects in mean scores
are summarized in Table 1, which replicates the
format of table 7 in the UK data except that the
d values are signed here to make it easier to see
which way the gender differences were: negative
where the mean for the women was higher (more
clinical) than for the men. For the clinical group,
the gender differences are markedly greater than
in the UK data except for the risk score; for the
non-clinical data the differences are very similar
to the UK data.
As expected, all domain scores were signifi cantly
positively inter-correlated as shown in Table 1,
both in the non-clinical and in clinical sample with
the risk items showing lower correlations with the
other scores (Table 2). As an indicator of dimen-
sionality, we plotted the scree plot (Cattell, 1966)
from the PCA (Figure 1), which shows the variance
in each independent component of variation in the
data of which there are 34 in these two samples.
Table 1. Gender difference in scores for non-clinical and clinical samples
Domain Non-clinical 95% CI for non-clinical Clinical 95% CI for clinical
(n = 71)
(n = 192)
Difference dMale
(n = 196)
(n = 443)
Difference d
Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Well-being 0.98 (0.69) 1.26 (0.85) 0.49 to 0.08 0.37 to 0.33 1.95 (0.93) 2.47 (0.94) 0.67 to 0.36 0.56 to 0.54
Symptoms 0.84 (0.60) 0.99 (0.65) 0.32 to 0.02 0.25 to 0.21 1.65 (0.78) 2.00 (0.86) 0.49 to 0.22 0.43 to 0.42
Functioning 1.04 (0.56) 1.01 (0.51) 0.12 to 0.18 0.05 to 0.08 1.56 (0.63) 1.68 (0.69) 0.23 to 0.01 0.18 to 0.17
Risk 0.16 (0.42) 0.11 (0.33) 0.06 to 0.16 0.13 to 0.17 0.38 (0.62) 0.44 (0.63) 0.16 to 0.05 0.09 to 0.08
Non-risk items 0.95 (0.55) 1.03 (0.56) 0.24 to 0.06 0.18 to 0.14 1.65 (0.66) 1.93 (0.72) 0.39 to 0.16 0.40 to 0.39
All items 0.81 (0.50) 0.87 (0.49) 0.20 to 0.07 0.15 to 0.11 1.43 (0.60) 1.66 (0.67) 0.34 to 0.13 0.37 to 0.35
Validation of CORE-OM 447
Copyright © 2009 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. 16, 444–449 (2009)
DOI: 10.1002/cpp
Table 2. Correlations between domain scores
Spearman’s rho WS F RRAll
Non-clinical (n = 251)
Well-being 1.00
Problems 0.78 1.00
Functioning 0.73 0.65 1.00
Risk 0.33 0.43 0.43 1.00
All non-risk items 0.89 0.92 0.88 0.45 1.00
All items 0.88 0.92 0.87 0.49 1.00 1.00
Alpha 0.75 0.86 0.76 0.74 0.92 0.92
95% CI alpha 0.70 to 0.79 0.84 to 0.88 0.71 to 0.80 0.69 to 0.78 0.90 to 0.93 0.91 to 0.93
Alpha in UK data 0.77 0.90 0.86 0.79 0.94 0.94
Clinical (n = 632)
Well-being 1.00
Problems 0.78 1.00
Functioning 0.71 0.67 1.00
Risk 0.50 0.57 0.49 1.00
All non-risk items 0.88 0.93 0.88 0.59 1.00
All items 0.87 0.93 0.87 0.66 0.99 1.00
Alpha 0.71 0.87 0.77 0.77 0.91 0.92
95% CI alpha 0.68 to 0.74 0.86 to 0.88 0.75 to 0.79 0.75 to 0.79 0.91 to 0.92 0.91 to 0.93
Alpha in UK data 0.75 0.88 0.87 0.79 0.94 0.94
W = well-being; S = problems/symptoms; F = functioning; R = risk; R = all items except the risk items; All = all 34 items; CI =
confi dence interval.
Figure 1. Scree plot of principal component analyses (PCA) item
Triangles and dashed lines for non-clinical data, circles and continuous lines for clinical
448 G. Palmieri et al.
Copyright © 2009 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. 16, 444–449 (2009)
DOI: 10.1002/cpp
As in the UK data for both clinical and non-
clinical datasets, both plots showed a dominant
rst component though slightly smaller than in the
UK data, here accounting for 33% of the variance in
both samples. The plots suggested an elbow after
three components, more clearly for the non-clinical
than the clinical data and are similar to the scree
plots from the UK data.
There were statistically signifi cant differences
between clinical and non-clinical datasets on all
scores, with effect size (Cohen’s d) ranging from
1.01 to 1.34 for the total score. The criteria for reli-
able and clinically signifi cant change are shown
in Table 3.
The Italian version of CORE-OM was well
accepted in respectably sized non-clinical and clin-
ical samples. As we had expected and hoped, the
translated version of the CORE-OM showed
respectable basic psychometric parameters of
internal consistency, discriminant and convergent
Internal consistency for the whole measure and
all domain scores was lower than that in the UK
referential data (Evans et al., 2002). However, the
consistencies are still very respectable for short
scales and all above 0.7.
For convergent validity, because this was an
unfunded study, we were only able to make a
comparison with the SCL-90R and only in a selected
subsample. These correlations, particularly for the
overall mean and non-risk scores, were very similar
to those in the British sample and, again, the corre-
lation with the problems/symptoms score was the
highest across the CORE-OM domain scores.
Though there were large and statistically signifi -
cant differences between clinical and non-clinical
datasets on all scores, the differences tended to be
Table 3. Criteria of reliable (RC) and clinically signifi cant (SC) change
Italy UK
Well-being 1.45 1.40 1.84 1.33 1.37 1.77
Symptoms 0.85 1.30 1.43 0.85 1.44 1.62
Functioning 0.89 1.29 1.30 0.84 1.29 1.30
Risk 0.83 0.25 0.22 0.95 0.43 0.30
All non-risk items 0.60 1.27 1.42 0.55 1.36 1.50
All items 0.52 1.09 1.20 0.51 1.19 1.29
smaller in the Italian than in the UK data. This may
partly refl ect interesting and quite marked differ-
ences between men and women in the Italian clini-
cal sample which do not parallel the UK gender
Exploratory PCA showed a strong fi rst compo-
nent similar to that in the UK sample but, though
large, the dataset is not suffi ciently large to support
detailed confi rmatory factor analysis such as that
of Lyne et al. (2006) which has explored the factor
structure of the CORE-OM in a very large UK clini-
cal sample. As expected of a short, multi-domain
measure, this was a complex structure and we
would expect to fi nd similar complexity if not
necessarily exactly the same structure when we
can collect the much larger Italian datasets needed
to explore differences in factor structures of that
For Jacobson’s reliable change criterion, based
on internal consistency and variance, not repeat
data, showed very similar criteria to those from the
original UK data since the slightly lower variance
in the Italian clinical data largely cancelled out
the effects of slightly lower internal consistency of
the translation. By contrast, the clinically signifi -
cant change criteria showed some moderate differ-
ences from the UK values with differences varying
across domain scores and between men and
women. Interestingly, the cutting points for the
women showed rather smaller differences between
Italy and the UK. This may refl ect vagaries of sam-
pling at this stage when the Italian referential data
are still relatively small in size. However, it seems
entirely plausible that non-clinical and clinical dis-
tributions of self-report scores on psychopathol-
ogy and functioning measures may well differ by
language and culture. Further analyses, comparing
much larger and representative datasets, both UK
and Italian, will throw more light on this and we
encourage others working with Italian-speaking
clients to contact the fi rst author about possible
Validation of CORE-OM 449
Copyright © 2009 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. 16, 444–449 (2009)
DOI: 10.1002/cpp
collaboration in accumulating large anonymous
datasets that would start to support the full refer-
ential possibilities now being explored in the UK
and other countries with the CORE system and
other similar systems.
Barkham, M., Margison, F., Leach, C., Lucock, M., Mellor-
Clark, J., Evans, C., Benson, L., Connell, J., Audin, K.,
& McGrath, G. (2001). Service profi ling and outcomes
benchmarking using the CORE-OM: Toward prac-
tice-based evidence in the psychological therapies.
Journal of Consulting and Clinical Psychology, 69, 184–
Cattell, R.B. (1966). The scree test for the number of
factors. Multivariate Behavioral Research, 1, 245–276.
Chiappelli, M., Grigoletti, L., Albanese, P., Taras, M.A.,
Tulli, P., Grassi, A., & Gruppo I-Psycost. (2007). The
cost and utilization of psychotherapy in community-
based mental health services. A multicentre study in
ve Italian areas. Epidemiologia e Psichiatria Sociale,
16(2), 152–62.
Connell, J., Barkham, M., Stiles, W.B., Twigg, E., Sin-
gleton, N., Evans, O., & Miles, J. (2007). Distribution
of CORE-OM scores in a general population, clinical
cut-off points and comparison with the CIS-R. British
Journal of Psychiatry, 190, 69–74.
Cronbach, L.J. (1951). Coeffi cient alpha and the internal
structure of tests. Psychometrika, 16, 297–34.
Derogatis, L.R. (1977). The SCL-R-90 manual I: Scoring,
administration and procedures for the SCL-90. Baltimore,
MD: Clinical Psychometric Research.
Evans, C., Connell, J., Barkham, M., Margison, F.,
McGrath, G., Mellor-Clark, J., & Audin, K. (2002).
Towards a standardised brief outcome measure: Psy-
chometric properties and utility of the CORE-OM.
British Journal of Psychiatry, 180(1), 51–60.
Evans, C., Connell, J., Barkham, M., Marshall, C., &
Mellor-Clark, J. (2003). Practice-based evidence:
Benchmarking NHS primary care counselling services
at national and local levels. Clinical Psychology & Psy-
chotherapy, 10, 374–388.
Evans, C.E., Margison, F., & Barkham, M. (1998) The con-
tribution of reliable and clinically signifi cant change
methods to evidence-based mental health. Evidence-
Based Mental Health, 1, 70–72.
Evans, C., Mellor-Clark, J., Margison, F., Barkham, M.,
McGrath, G., Connell, J., & Audin, K. (2000). CORE:
Clinical outcomes in routine evaluation. Journal of
Mental Health , 9(3), 247–255.
Gallo, E., & Rucci, P. (2000). Supply, demand and pre-
dictive factors of psychotherapies in 10 community
mental health services in Emilia Romagna. Epidemiolo-
gia e Psichiatria Sociale, 9(2), 103–112.
Jacobson, N. S., & Truax, P. (1991). Clinical signifi cance:
A statistical approach to defi ning meaningful change
in psychotherapy research. Journal of Consulting and
Clinical Psychology, 59, 12–19.
Lomazzi, L., Fava, E., Landra, S., D’Angelo, P., Lam-
moglia, M., Pazzi, E., Calini, P., Arduini, L., Barattini,
D., & Carta, I. (1997). Psychotherapies in psychosocial
centers in Lombardia: a point of view of psychiatrists
and psychologists, Epidemiologia e Psichiatria Sociale,
6(3), 184–193.
Lyne, J., Barrett, P., Evans, C., & Barkham, M. (2006).
Dimensions of variation on the CORE-OM amongst
patients attending for psychological therapy. British
Journal of Clinical Psychology, 45(2), 185–203.
R Development Core Team (2009). R: A language and
environment for statistical computing. Vienna, Austria: R
Foundation for Statistical Computing.
Shepherd, M., Ashworth, M., Evans, C., Robinson, S.,
Rendall, M., & Ward, S. (2005). What factors are asso-
ciated with improvement after brief psychological
interventions in primary care? Issues arising from
using routine outcome measurement to inform clini-
cal practice. Counselling and Psychotherapy Research,
5(4), 273–280.
Spitzer, R.L, Gibbon, M., Williams, J.B.W., & Endicott, J.
(1994). Global Assessment of Functioning (GAF) Scale.
In L.I. Sederer & B. Dickey (Eds.), Outcomes assessment
in clinical practice (pp. 76–78, 182). Baltimore: Williams
and Wilkins.
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In intensive transactional analysis psychotherapy (ITAP), intensity is obtained with both technical expedients and the relational manner with the patient. In ITAP, the therapist modulates pressure and support commensurately to the patients' ego strength. In the present article, we contrast two clinical cases of young adults in which ego strength produced different therapy outcomes and processes. We present excerpts of the psychotherapy process that illustrates technical aspects of ITAP as well as the therapist's attitude that we describe as holding. We show quantitative therapy outcomes consisting of effects size values of changes in Clinical Outcome in Routine Evaluation-Outcome Measure scores in baseline, treatment, and follow-up phases and qualitative outcome evaluated with the Change Interview at the end of the therapy. In the patient with high ego strength, we observed a rapid improvement and a complete recovery at the end of the therapy, whereas the results of the patient with low ego strength were less consistent (more fluctuations in Clinical Outcome in Routine Evaluation-Outcome Measure scores including deterioration but good qualitative outcome). We conclude that quantitative and qualitative outcome data, together with process observations, are required to have a complete picture of therapy effectiveness. Moreover, we conclude that qualitative ego strength is not a limitation for the use of expressive therapy such as ITAP, but rather, it is an important variable that should be considered to dose confrontations and support.
... CE has co-led 44 translations of CORE self-report measures (e.g. Gampe et al., 2007;Palmieri et al., 2009;Paz, Mascialino, et al., 2020) and contributed to a review of translation methods (Hall et al., 2017). He suspects his interest in translations came from his 'romantically Welsh' origins and the history of suppression of Welsh as a language. ...
One of the key challenges that counsellors and psychotherapists may now find themselves encountering is that of working with clients whose native language is not English. This is of particular importance when using psychological assessment tools published in English to ascertain difficulties in a client's native language and utilising these tools to help in assessing the level of risk, whether this be done through an interpreter or a multilingual therapist delivering therapy in their native language. This paper takes the reader through the process of translating the YP-CORE assessment tool from English (original version) to Arabic; it draws on the crucial personal involvements and experiences vital to good translation work and how a good translation must be informed by the challenges of delivering therapies in multicultural settings. The process illustrates some of the cultural (and possibly religious) influences that were at play during the translation process for the young people and their families. This article highlights the importance of cultural sensitivity and competence, as well as religious implications, that some individuals from an Arab or Muslim background might experience in relation to accessing counselling/psychotherapy or even just being seen to support such psychological services (as was the case for translating the YP-CORE). The crucial outcome of successfully creating an Arabic version of YP-CORE, which is now published online and available for use by professionals, also brings with it a cultural awareness of Arabic-speaking cultures and the possible implications of these when delivering counselling or psychotherapy and when constructing policies.
Background: Despite mounting evidence for the powerful influence of smell and taste substances in experimental pain, our knowledge of their effects in the clinical context is scarce, especially for patients with chronic oral burning pain. To fill this gap, we investigated the effect of olfactory and gustatory stimuli on pain perception in patients with chronic oral burning pain, a disabling condition that is difficult to manage and treat. Methods: Twenty-two patients with chronic oral burning pain underwent testing with a variety of olfactory and gustatory substances (pleasant, neutral, unpleasant) in multisensory interaction. The order of testing was randomized. Perception of pain intensity and unpleasantness was evaluated on a numerical rating scale at baseline and immediately after each test trial. Results: Pain unpleasantness but not pain intensity was found to be modulated by chemosensory stimuli. Unpleasant olfactory and gustatory stimuli increased the perception of pain unpleasantness compared to pleasant and neutral stimuli. Pain unpleasantness after unpleasant olfactory and gustatory stimuli correlated with psychological questionnaire subscale scores for distress (CORE-OM) and emotional awareness (TAS-20). Conclusions: Our findings suggest a role of unpleasant chemosensory stimuli in increasing the perception of pain unpleasantness in patients with chronic oral burning. The lack of an effect on pain intensity indicates a dissociation between sensory and affective pain components. Future research is needed to further study the association between chemosensory stimuli and emotional and subjective aspects in modulating chronic oral burning pain.
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Monografija Raziskovanje v psihoterapiji in integracija psihoterapevtskih pristopov podaja podrocni pregled raziskovanja in integracije v psihoterapiji. Avtorja v monografiji obravnavata metode psihoterapevtskega raziskovanja, raziskave ucinkovitosti in izidov psihoterapije ter raziskave procesov psihoterapije. Pri tem se se posebej usmerjata na podrocje skupnih faktorjev psihoterapije, ki predstavlja osnovo za integracijo psihoterapevtskih pristopov. Osredotocata se na pomemben premik v paradigmi raziskovanja psihoterapije, ki se namesto raziskovanja ucinkovitosti posameznih smeri psihoterapije usmerja na raziskovanje principov in procesov, ki so v ozadju razlicnih psihoterapevtskih pristopov. Premik v pradigmi raziskovanja k procesom spremembe je skladen tudi z vse bolj vplivnim gibanjem psihoterapevtske integracije, ki se ukvarja z odprtim raziskovanjem podobnosti in razlik med razlicnimi psihoterapevtskimi pristopi. V monografiji je podan pregled gibanja psihoterapevtske integracije od njenih zacetkov do sodobnih pristopov. Avtorja predstavita temeljne sodobne integrativne pristope, ki skusajo na razlicne nacine integrirati spoznanja razlicnih psihoterapevtskih smeri. V zadnjem poglavju se usmerita na raziskave psihoterapevtske integracije in predstavita slovensko raziskavo integrativne psihoterapije, ki jo je izvedla Karmen Urska Modic. Monografija v Sloveniji predstavlja pomembno novost, saj na celosten nacin obravnava raziskovanje in integracijo v psihoterapiji, pomembna pa je tudi mednarodno, saj avtorja predstavita rezultate lastnih raziskav integrativne psihoterapije. / The monograph Research in Psychotherapy and Integration of Psychotherapy Approaches brings a review of the field of research in psychotherapy and psychotherapy integration. It is focused on research methods in psychotherapy, outcome studies, and process research. The authors focus in particular on the common factors in psychotherapy, which are the basis for psychotherapy integration. They describe an important paradigm shift in the psychotherapy research, which, instead of focusing on the effectiveness of particular psychotherapy approaches, concentrates on the principles and processes of change that underly different psychotherapy schools. This paradigm shift toward the processes of change is congruent with the increasingly influential movement of psychotherapy integration, which is interested in exploring commonalities and differences between different psychotherapy schools. The book explores the field of psychotherapy integration from its historical roots to its contemporary concepts, identifying the key current integrative approaches that aim to integrate insights from different psychotherapy schools in various ways. The final chapter discusses research in psychotherapy integration and outlines the research on integrative psychotherapy conducted by Karmen Urska Modic. The monograph brings important new insights into the Slovenian field of psychotherapy as it comprehensively discusses research and integration in psychotherapy, while also being important internationally as the authors present their research findings related to integrative psychotherapy.
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This study attempts to adapt and validate the Spanish version of The Clinical Outcomes in Routine Evaluation-Outcome Measure CORE-OM questionnaire for Colombian and Peruvian populations. A linguistic and cultural adaptation of the CORE-OM Spanish version was created via cognitive interviews of potential users (Colombians n=28; Peruvians n=8). Then the questionnaire was applied along with the SOS and OQ-45 tests to 270 participants, divided in clinical (n=60), and non-clinical (n=210) samples, from three Colombian cities and one city in Peru. Some students made a retest application (n=26) 15 to 30 days after the first one. The CFA conducted showed a four-factor structure (χ 2 /df=2.09; RMSEA=0.064; RMR=.069) that included well-being, problems/symptoms, general functioning, and risk. The Spanish version of CORE-OM showed excellent acceptability (96%; omission rate 0.14%), good internal consistency (α >.70 in most of the scales and samples), acceptable test-retest reliability (Spearman rho>0.70; p<.001) and convergent validity (all domains r > .4; p < 0.01, except subjective well-being) in both populations. Significant differences were found in the scores between the clinical and non-clinical sample; although, the clinical sample presented higher scores. These results validate the 1-point cutoff score of between clinical and non-clinical populations.
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Background: Mindfulness-based interventions (MBIs) are known for their beneficial effects on positive and negative psychological factors. When applied in an occupational context, MBIs might help workers to cope with stress, increase their professional outcomes and wellbeing. Objective: In this two-groups pre-post experimental design we tested the effect of our MBI, called Integral Meditation (IM), among the employers of an Italian service company by measuring positive and negative aspects of psychological wellbeing related to mindfulness and workplace functioning through eight self-report questionnaires (CORE-OM, FFMQ, WEMWBS, MAIA, PSS, PANAS, STAI-X1, SCS). Method: Forty-two voluntary non-clinical employers of the company, randomly assigned to the experimental or the control group, were analyzed. The experimental group underwent our IM program, which consists of 12 weekly meditation classes given after the afternoon shift, while the control group did not receive any intervention. Data was analyzed via linear mixed models. Results: Statistically significant results were obtained for FFMQ observing subscale (β= 0.49, p = 0.014), WEMWBS (β= 5.31, p = 0.02), PSS (β= -3.31, p = 0.03), the whole scale of SCS (β= 0.47, p = 0.01) and self-judgment (β= 0.68, p = 0.003) and isolation (β= -0.66, p = 0.01) SCS subscales. Statistically significant results were also found in four out of eight subscales of MAIA: emotional awareness (β= 1.26, p < 0.001), self-regulation (β= 1.28, p < 0.001), body listening (β= 1.08, p < 0.001) and trusting (β= 1.1, p < 0.001). Conclusion: Our intervention has demonstrated to bring beneficial effects in a mindfulness subdomain, in perceived stress, self-compassion, interoception and psychological wellbeing. Based on our results, we conclude that our intervention was effective in increasing the positive aspects of wellbeing and in reducing stress.
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To complement the evidence-based practice paradigm, the authors argued for a core outcome measure to provide practice-based evidence for the psychological therapies. Utility requires instruments that are acceptable scientifically, as well as to service users, and a coordinated implementation of the measure at a national level. The development of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is summarized. Data are presented across 39 secondary-care services ( n = 2,710) and within an intensively evaluated single service ( n = 1,455). Results suggest that the CORE-OM is a valid and reliable measure for multiple settings and is acceptable to users and clinicians as well as policy makers. Baseline data levels of patient presenting problem severity, including risk, are reported in addition to outcome benchmarks that use the concept of reliable and clinically significant change. Basic quality improvement in outcomes for a single service is considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Study purpose: This descriptive study used a routine practice dataset to investigate whether demographic variables and intervention length were associated with outcome after brief psychological interventions in primary care.Brief description of the participants: The data are from 3687 adults with a wide range of presenting problems, from a culturally diverse inner London borough, referred to primary care psychologists and counsellors.Methodology: Demographic and service activity data were routinely collected using a local monitoring form and self-report outcome data using the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). The paradigm of reliable and clinically significant change was used to explore individual as well as group change. The relationship between demographic variables, intervention length and outcome was investigated.Results, conclusions and implications: Sixty-six per cent of the group with complete outcome data (n = 458) showed reliable improvement and 45% also showed clinically significant improvement after the intervention. Ethnicity was not related to outcome, suggesting that the service was not culturally biased in this respect (although clients from ethnic minorities were significantly underrepresented in the sample of clients who attended). Women and employed clients were more likely to show improvement. Unemployed men had comparatively poor outcomes. There was a positive relationship between length of intervention and improvement. As is often the case, client and data attrition were high: the small sample for which complete outcome data were available reduced the representativeness and generalisability of the findings which must therefore be treated with caution. Issues of attrition must be addressed in future to ensure that data quality is sufficient to increase confidence in using it for service management, development and ‘benchmarking’. However, the study adds to the growing body of ‘practice-based evidence’ supporting the provision of primary care psychology and counselling services. The findings suggest that the employment status and gender of clients may both need to be considered when ‘benchmarking’ outcomes
Objective The purpose of this study is the systematic analysis of operators' points of view about psychotherapies concretely performed in the Public Psychiatric Public Services and inside the global operating mode of the assistance. Setting – The study has involved 26 CPS selected randomly in Lombardia. The sample has been built with 73 psychiatrists and 42 psychologists. Main outcome measures – All the therapeutists involved in this research have been submitted to a question-form querying socio-anagraphic data, professional training, orientations, operating modes in their CPS, rules and objectives of their psycotherapies, observations and evaluations about psychoterapic treatments and their effects. Results and conclusions: Psychiatrists and psycologists working in CPS, mostly the younger ones (less than 45 years old), followed a personal training in over the 70% of the cases. The prevalent orientation is the psycoanalityc one in both the categories. The most part of therapeutists deems that there has been an evolution in their way of conceiving psychiatry inside the public service. The lines at these evolutions have been mentioned explicitly in the article. Psychiatrists and psycologists, even with some concrete differences, seems to have mostly homogeneous points of view: psychiatrists have a more flexible vision of which practices can be considered as a psychotherapy, whereas psycologists are more rigorously linked to theoric reference models and to rules learnt during their training. They are both slightly favourable to the use of psychotherapies in their services, even if, as a matter of fact, they are used by just a few patients. No contrast between psycotherapy and psycopharmacology has been detected from operators' answers. These practices seem to be both considered useful and integrable.
A general formula (α) of which a special case is the Kuder-Richardson coefficient of equivalence is shown to be the mean of all split-half coefficients resulting from different splittings of a test. α is therefore an estimate of the correlation between two random samples of items from a universe of items like those in the test. α is found to be an appropriate index of equivalence and, except for very short tests, of the first-factor concentration in the test. Tests divisible into distinct subtests should be so divided before using the formula. The index [`(r)]ij\bar r_{ij} , derived from α, is shown to be an index of inter-item homogeneity. Comparison is made to the Guttman and Loevinger approaches. Parallel split coefficients are shown to be unnecessary for tests of common types. In designing tests, maximum interpretability of scores is obtained by increasing the first-factor concentration in any separately-scored subtest and avoiding substantial group-factor clusters within a subtest. Scalability is not a requisite.
Can different therapists, motivated by different theories and working in different settings, find a single measure - a "core" - for monitoring their work? This paper introduces the Clinical Outcomes in Routine Evaluation (CORE) outcome measure, its philosophy, practice and utility. The measure is brief and acceptable to clients and therapists. It covers well being, problems/symptoms, life functioning and risk to self and others. It is easily scored by hand and computer scannable. It measures individual differences on entry into therapy and change. Analyses of over 2,000 responses show good reliability and convergent validity against longer and less general measures; small gender effects; large clinical/non-clinical differences and good sensitivity to change. Referential clinical and non-clinical distributions and reliability enable calculation of clinically significant and reliable change criteria. Two short forms are available for frequent use within therapy and a centrally supported system will scan questionnaires and provide standardised reports and raw data. [Abstract, p. 247]