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Direct retrospective measurement of therapeutic changes: an example using the Czech version of the Questionnaire of Personal Changes (Q-PC)
Psychotherapy Research
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In 2 studies, clients were asked, after terminating psychotherapy, to complete a measure of symptomatic distress exactly as they had in their pre-therapy assessment. Most clients overestimated their pre-therapy distress, which may lead to an illusion of positive change. A 3rd study found no overestimation of previously reported distress in a control sample. The degree of overestimation for psychotherapy clients was positively correlated with anxiety, depression, and neuroticism, and negatively correlated with ego strength, self-deception, and lying. Distress levels at termination mediated these effects of individual differences. Individual differences were also correlated with specific types of recall error, such as adding to, exaggerating, omitting, and minimizing previously reported symptoms. Misremembering prior emotions may both reflect and create individual differences.
Several factors can cause posttherapy scores to regress (relative to pretherapy scores) toward a group mean. This article focuses on regression effects that are due to measurement error, and on methods used to evaluate pre- to posttherapy score changes that attempt to take these regression effects into account. Statistical and practical problems associated with these methods are discussed. In particular, a statistical problem is identified in the most recent article that advocates use of these methods. Consequences of ignoring this problem and a way of correcting it are presented. Five practical problems encountered in using a correct classical true-score theory method of identifying reliable changes (based on derivations of H. Gulliksen [1950] and F. M. Lord and M. R. Novick [1968]) are then presented. Finally, objectives of these methods are distinguished from objectives of other strategies used to evaluate changes in psychotherapy.
Daily mood ratings and corresponding diary entries were studied to determine relations between common events and two independent mood factors—Positive Affect (PA) and Negative Affect (NA)—in a sample of 18 young adults over a 3-month period. In an extension of findings from earlier interindividual studies, PA (enthusiastic, delighted vs. sluggish, drowsy) was found to be associated with a wide range of daily events, whereas fewer correlations were found between these events and NA (distressed, nervous, angry vs. calm, relaxed). The relation between high PA and reported social interactions (particularly physically active social events) was especially robust, and its effects were noted repeatedly; NA was unrelated to social activity. As hypothesized, high NA was associated with physical problems; contrary to expectations, low PA also tended to be correlated with health complaints. Overall, the results reaffirm the importance of assessing NA and PA independently and suggest that PA is an interesting and important dimension that deserves more research attention. Theoretical considerations and clinical implications are discussed.
Psychotherapy is expected to be effective in the treatment of patients with medically unexplained physical symptoms (MUPS). However, evidence is scarce. The aim of this study was to examine the effectiveness of a multicomponent treatment based on group therapy in patients with MUPS in a naturalistic setting and to explore potential predictors of the outcomes. A multisite naturalistic uncontrolled effectiveness study. A total of 290 patients with MUPS participated in group psychotherapy across seven clinical sites. Somatic symptoms, depression, anxiety, general psychotherapy outcomes operationalized as the Outcome Rating Scale (ORS) score, well-being, role functioning interference, as well as a number of pretreatment predictors were measured using a battery of self-report measures. Multilevel modeling and lasso regression with bootstrapping were used for the analysis. Medium to large pre-post effects were found for somatic symptoms, ORS, depression, anxiety, well-being, role functioning interference found in completers after controlling for site and group effects, pretreatment outcome values, and treatment length. Changes reported at 6- and 12-month follow-up were higher for most variables. No substantial pretreatment predictors of the patients’ posttreatment status were found in addition to the pretreatment level of outcome variables. Somatic symptoms seem to be less malleable in psychotherapy than psychological outcome variables. However, there was a trend of further improvement after treatment completion.
Registration
This study was retrospectively registered with ISRCTN (Identifier 13532466).
Understanding psychological mechanisms of change is essential to advance treatments for patients suffering from medically unexplained physical symptoms (MUPS). This study aimed to test the role of selected change mechanisms (incl. interoceptive awareness, emotional regulation skills, symptom acceptance, relational needs satisfaction, clarification of meaning, working alliance, and group cohesion) in the modification of patients' somatic symptom intensity and well-being.
N = 290 patients suffering from MUPS participated in a multi-component group-based treatment at seven clinical sites. Data were collected weekly. Multi-level modeling was used to test cross-lagged relationships between the hypothesized mechanisms and outcomes in terms of Granger causality (with lags of 1, 2, and 3 weeks).
None of the mechanisms predicted a time-lagged change in outcomes in the expected direction. In fact, there was a consistent pattern of negative time-lagged relationships (i.e., an increase in a mechanism predicted worsening of the outcome). Findings consistent with the hypothesized role of the mechanisms were found only in concurrent relationships between mechanisms and outcomes.
This study did not support time-lagged relationships under the condition of weekly measurement and many methodological factors remain to be considered (e.g., a finer time resolution).
Client self-report symptom measures are widely used in counselling and
psychotherapy research and practice to track client progress and evaluate
outcome. A growing body of evidence indicates differences between selfreport assessments and information collected through other sources. This
paper considers a range of theoretical and empirical perspectives on this
issue, including the concept of illusory mental health. Particular emphasis is
given to the relevance of single-case research as a means of identifying
different patterns of paradoxical outcome. Implications for practice and
research are discussed.
Purpose
The extant response shift definitions and theoretical response shift models, while helpful, also introduce predicaments and theoretical debates continue. To address these predicaments and stimulate empirical research, we propose a more specific formal definition of response shift and a revised theoretical model.
Methods
This work is an international collaborative effort and involved a critical assessment of the literature.
Results
Three main predicaments were identified. First, the formal definitions of response shift need further specification and clarification. Second, previous models were focused on explaining change in the construct intended to be measured rather than explaining the construct at multiple time points and neglected the importance of using at least two time points to investigate response shift. Third, extant models do not explicitly distinguish the measure from the construct. Here we define response shift as an effect occurring whenever observed change (e.g., change in patient-reported outcome measures (PROM) scores) is not fully explained by target change (i.e., change in the construct intended to be measured). The revised model distinguishes the measure (e.g., PROM) from the underlying target construct (e.g., quality of life) at two time points. The major plausible paths are delineated, and the underlying assumptions of this model are explicated.
Conclusion
It is our hope that this refined definition and model are useful in the further development of response shift theory. The model with its explicit list of assumptions and hypothesized relationships lends itself for critical, empirical examination. Future studies are needed to empirically test the assumptions and hypothesized relationships.
The traditional pre-post treatment difference reflects an incremental notion of change, where a quantity of some psychological function is added to (or subtracted from) a pretreatment quantity. This study presents a complementary, experiential notion of change. Rather than a difference, change is a feeling or experience of having changed, a feeling that one is different than before. Based on a post-treatment interview the Change after Psychotherapy (CHAP) is a method to quantify/rate such ‘differentness’ in terms of how extensively or radically the patient feels having changed. A pre-post quasi-experimental study (N = 49) comparing the CHAP with ratings on the Global Assessment of Functioning, the Karolinska Psychodynamic Profile and the Comprehensive Psychopathological Rating Scale-Self-Affective is reported. The results showed the CHAP to be a reliable, valid and sensitive way to assess an experiential kind of CHAP.
The long-standing topic of how to represent and measure change in behavioral sciences is examined. We contend that focusing on change processes such as growth and development intrinsically requires one to operationalize three fundamental and intimately connected concepts—measurement, design, and analysis. In the measurement section, we discuss some historical developments such as initial attempts to obtain “ostensive” characteristics of behavioral abstractions, some controversies surrounding difference scores and regression toward the mean, and the various factor analytic approaches offered by Cattell’s (1952) data box. We also examine more recent measurement schemes, such as multivariate representations of change and latent difference scores. In the design section, we stress the importance of a proper selection of occasions of measurement, and we discuss recent advances, such as planned incompleteness of data and the use of minilongitudinal studies to overcome practical difficulties. Finally, in the modeling section, we discuss newer modeling approaches, such as dynamic factor models and dampened linear oscillator models. While not settling any of the historical controversies, we contend that the more recent and promising methodological innovations for studying change discussed here, although not a solution, represent a much needed step toward the fundamental goal of more adequately representing and measuring change.
This chapter highlights the potential and variety of qualitative methods that can be applied to counselling and psychotherapy outcome research. The chapter’s main focus is on outlining the various forms of qualitative data collection methods that are available to researchers. This is followed by an overview of the various qualitative analysis methods that can be utilised for interpreting the data. Finally, the limitations of qualitative outcome research are discussed, including a number of approaches evaluating the credibility of such research.
The 5-item World Health Organization Well-Being Index (WHO-5) is among the most widely used questionnaires assessing subjective psychological well-being. Since its first publication in 1998, the WHO-5 has been translated into more than 30 languages and has been used in research studies all over the world. We now provide a systematic review of the literature on the WHO-5.
We conducted a systematic search for literature on the WHO-5 in PubMed and PsycINFO in accordance with the PRISMA guidelines. In our review of the identified articles, we focused particularly on the following aspects: (1) the clinimetric validity of the WHO-5; (2) the responsiveness/sensitivity of the WHO-5 in controlled clinical trials; (3) the potential of the WHO-5 as a screening tool for depression, and (4) the applicability of the WHO-5 across study fields.
A total of 213 articles met the predefined criteria for inclusion in the review. The review demonstrated that the WHO-5 has high clinimetric validity, can be used as an outcome measure balancing the wanted and unwanted effects of treatments, is a sensitive and specific screening tool for depression and its applicability across study fields is very high.
The WHO-5 is a short questionnaire consisting of 5 simple and non-invasive questions, which tap into the subjective well-being of the respondents. The scale has adequate validity both as a screening tool for depression and as an outcome measure in clinical trials and has been applied successfully across a wide range of study fields. © 2015 S. Karger AG, Basel.
Interpretations of data in qualitative research may be biased for many reasons. This paper explores three commonly overlooked problems from a rather positivist point of view and deals with them mainly through the lens of cognitive psychology and survey methodology. The first problem is that researchers and readers of the research tend to trust retrospective data too much even though it is known that our memory is highly reconstructive. The second problem is that we often create interpretations too quickly and do not ground them in data well. The third problem is inappropriately generalising our findings because we underrate the variability of the phenomena studied. The aim is not to employ quantitative criteria in qualitative research but to show that especially in cases where we seek more objectivity (e.g., factual information about events) and less about the subjective phenomenal world (e.g., how people perceive these events from today’s perspective), cognitive psychology or survey methodology can offer valuable insights. Recommendations about what researchers should be careful of and how to increase the objectivity of the interpretations are offered.
Mental disorders traditionally have been viewed as distinct, episodic, and categorical conditions. This view has been challenged by evidence that many disorders are sequentially comorbid, recurrent/chronic, and exist on a continuum. Using the Dunedin Multidisciplinary Health and Development Study, we examined the structure of psychopathology, taking into account dimensionality, persistence, co-occurrence, and sequential comorbidity of mental disorders across 20 years, from adolescence to midlife. Psychiatric disorders were initially explained by three higher-order factors (Internalizing, Externalizing, and Thought Disorder) but explained even better with one General Psychopathology dimension. We have called this dimension the p factor because it conceptually parallels a familiar dimension in psychological science: the g factor of general intelligence. Higher p scores are associated with more life impairment, greater familiality, worse developmental histories, and more compromised early-life brain function. The p factor explains why it is challenging to find causes, consequences, biomarkers, and treatments with specificity to individual mental disorders. Transdiagnostic approaches may improve research.
Structural equation modeling (SEM) is a vast field and widely used by many applied researchers in the social and behavioral sciences. Over the years, many software pack-ages for structural equation modeling have been developed, both free and commercial. However, perhaps the best state-of-the-art software packages in this field are still closed-source and/or commercial. The R package lavaan has been developed to provide applied researchers, teachers, and statisticians, a free, fully open-source, but commercial-quality package for latent variable modeling. This paper explains the aims behind the develop-ment of the package, gives an overview of its most important features, and provides some examples to illustrate how lavaan works in practice.
A mental health enterprise may be described by either (a) rather general philosophical total mental health goals, or (b) highly diverse and individualized patient-therapist goals. Goals a. have not provided a workable framework for program evaluation. This paper proposes that evaluation be done in the framework of goals b. by setting up, before treatment, a measurable scale for each patient-therapist goal, and specifying, for each patient, a transformation of his overall goal attainment into a standardized T-score. This method, together with random assignment of patients to treatment modes, was devised to permit comparison of treatment modes within a program, but it also provides a good basis for a judgmental evaluation of the total program.
Industry-wide, there is a trend toward making outcome evaluation a routine part of therapeutic services. Although various multidimensional assessments of outcome are valid and reliable, their methodological complexity, length of administration, and cost often render them infeasible for many service providers and settings. The present article describes the development and validation of an ultra-brief outcome measure, the Outcome
Rating Scale (ORS). The instrument’s psychometric properties are examined and reported
for both clinical and nonclinical samples. Based on experience with the instrument at the various sites in the study, the feasibility of the scale is considered. Results indicate that the ORS represents a balanced trade-off between the reliability and validity of the longer measures, and the feasibility of this brief scale. Results and implications for clinical practice and future research are discussed.
The efficacy of treatments for depression is often measured by comparing observed total scores on self-report inventories, in both clinical practice and research. However, the occurrence of response shifts (changes in subjects' values, or their standards for measurement) may limit the validity of such comparisons. As most psychological treatments for depression are aimed at changing patients' values and frame of reference, response shifts are likely to occur over the course of such treatments. In this article, we tested whether response shifts occurred over the course of treatment in an influential randomized clinical trial. Using confirmatory factor analysis, measurement models underlying item scores on the Beck Depression Inventory (Beck & Beamesderfer, 1974) of the National Institute of Mental Health Treatment of Depression Collaborative Research Program (Elkin, Parloff, Hadley, & Autry, 1985) were analyzed. Compared with before treatment, after-treatment item scores appeared to overestimate depressive symptomatology, measurement errors were smaller, and correlations between constructs were stronger. These findings indicate a response shift, in the sense that participants seem to get better at assessing their level of depressive symptomatology. Comparing measurement models of patients receiving psychotherapy and medication suggested that the aforementioned effects were more apparent in the psychotherapy groups. Consequently, comparisons of observed total scores on self-report inventories may yield confounded measures of treatment efficacy. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
With the rise in efforts to evaluate the quality of mental health care and its outcomes, the measurement of change has become an important topic. This paper tracks the creation of a new instrument designed to assess psychotherapy outcome. The Outcome Questionnaire (OQ) was designed to include items relevant to three domains central to mental health: subjective discomfort, interpersonal relations, and social role performance. This study describes the theoretical development and psychometric properties of the OQ. Psychometric properties were assessed using clinical, community, and undergraduate samples. The OQ appears to have high reliability and evidence to suggest good concurrent and construct validity of the total score. The data presented show that it distinguishes patient from non-patient samples, is sensitive to change, and correlates with other measures of patient distress.
The article addresses some concerns about how coefficient alpha is reported and used. It also shows that alpha is not a measure of homogeneity or unidimensionality. This fact and the finding that test length is related to reliability may cause significant misinterpretations of measures when alpha is used as evidence that a measure is unidimensional. For multidimensional measures, use of alpha as the basis for corrections for attenuation causes overestimates of true correlation. Satisfactory levels of alpha depend on test use and interpretation. Even relatively low (e.g., .50) levels of criterion reliability do not seriously attenuate validity coefficients. When reporting intercorrelations among measures that should be discriminable, it is important to present observed correlations, appropriate measures of reliability, and correlations corrected for unreliability.
In this article, I outline hermeneutic single-case efficacy design (HSCED), an interpretive approach to evaluating treatment causality in single therapy cases. This approach uses a mixture of quantitative and qualitative methods to create a network of evidence that first identifies direct demonstrations of causal links between therapy process and outcome and then evaluates plausible nontherapy explanations for apparent change in therapy. I illustrate the method with data from a depressed client who presented with unresolved loss and anger issues.
In past years, various theoretical conceptualizations of therapeutic outcome have been proposed. Differences based on pre post and retrospective measurements were found (Michalak et al., 2003). In the current study, a sample of 263 patients completed seven questionnaires pre- and posttreatment or retrospectively. The results were examined with explorative and confirmative factor analyses. The authors found high intercorrelations and internal consistency over all seven questionnaires (Cronbachs a 0/ .85). In confirmatory factor analyses, a three-factor model encompassing global retrospective, multi-item retrospective, and prepost measures has the best fit indexes. Retrospective and prepost measures are equally mood dependent at posttreatment measurements. Regression effects are observed only with prepost measures.
Results of reliability and agreement studies are intended to provide information about the amount of error inherent in any diagnosis, score, or measurement. The level of reliability and agreement among users of scales, instruments, or classifications is widely unknown. Therefore, there is a need for rigorously conducted interrater and intrarater reliability and agreement studies. Information about sample selection, study design, and statistical analysis is often incomplete. Because of inadequate reporting, interpretation and synthesis of study results are often difficult. Widely accepted criteria, standards, or guidelines for reporting reliability and agreement in the health care and medical field are lacking. The objective was to develop guidelines for reporting reliability and agreement studies.
Eight experts in reliability and agreement investigation developed guidelines for reporting.
Fifteen issues that should be addressed when reliability and agreement are reported are proposed. The issues correspond to the headings usually used in publications.
The proposed guidelines intend to improve the quality of reporting.
In 1984, Jacobson, Follette, and Revenstorf defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operationalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change.
In a fourfold table showing binary agreement of two observers, the observed proportion of agreement, p0, can be paradoxically altered by the chance-corrected ratio that creates kappa as an index of concordance. In one paradox, a high value of p0 can be drastically lowered by a substantial imbalance in the table's marginal totals either vertically or horizontally. In the second pardox, kappa will be higher with an asymmetrical rather than symmetrical imbalanced in marginal totals, and with imperfect rather than perfect symmetry in the imbalance. An adjustment that substitutes kappa max for kappa does not repair either problem, and seems to make the second one worse.
To assess trends in the use of self-report measures in research on adherence to practice guidelines since 1980, and to determine the impact of response bias on the validity of self-reports as measures of quality of care.
We conducted a MEDLINE search using defined search terms for the period 1980 to 1996. Included studies evaluated the adherence of clinicians to practice guidelines, official policies, or other evidence-based recommendations. Among studies containing both self-report (e.g. interviews) and objective measures of adherence (e.g. medical records), we compared self-reported and objective adherence rates (measured as per cent adherence). Evidence of response bias was defined as self-reported adherence significantly exceeding the objective measure at the 5% level.
We identified 326 studies of guideline adherence. The use of self-report measures of adherence increased from 18% of studies in 1980 to 41% of studies in 1985. Of the 10 studies that used both self-report and objective measures, eight supported the existence of response bias in all self-reported measures. In 87% of 37 comparisons, self-reported adherence rates exceeded the objective rates, resulting in a median over-estimation of adherence of 27% (absolute difference).
Although self-reports may provide information regarding clinicians' knowledge of guideline recommendations, they are subject to bias and should not be used as the sole measure of guideline adherence.
An acceptable, standardised outcome measure to assess efficacy and effectiveness is needed across multiple disciplines offering psychological therapies.
To present psychometric data on reliability, validity and sensitivity to change for the CORE-OM (Clinical Outcomes in Routine Evaluation--Outcome Measure).
A 34-item self-report instrument was-developed, with domains of subjective well-being, symptoms, function and risk. Analysis includes internal reliability, test-retest reliability, socio-demographic differences, exploratory principal-component analysis, correlations with other instruments, differences between clinical and non-clinical samples and assessment of change within a clinical group.
Internal and test-retest reliability were good (0.75-0.95), as was convergent validity with seven other instruments, with large differences between clinical and non-clinical samples and good sensitivity to change.
The CORE-OM is a reliable and valid instrument with good sensitivity to change. It is acceptable in a wide range of practice settings.
Research and policymaking on positive mental health and well-being have increased within the last decade, partly fueled by decreasing levels of well-being in the general population and among at-risk groups. However, measurement of well-being often takes place in the absence of reflection on the underlying theoretical conceptualisation of well-being. This disguises the fact that different rating scales of well-being often measure very different phenomena because rating scales are based on different philosophical assumptions, which represent radically different foundational views about the nature of well-being. The aim of this paper is to examine the philosophical foundation of the Well-Being Index WHO-5 in order to clarify the underlying normative commitments and the psychometric compromises involved in the translation of philosophical theory into practice. WHO-5 has been introduced as a rating scale that measures the affective and hedonistic dimensions of well-being. It is widely used within public health and mental health research. This paper introduces the philosophical theory of Hedonism and explores how two central assumptions that relate to hedonistic theory are reflected in the construction of WHO-5. The first concerns ‘the hedonic balance’, that is the relation between positive and negative emotions. The second assumption concerns ‘the value of emotions’, that is, how to determine the duration and intensity of emotions. At the end, Hedonism is contrasted with Life Satisfaction Theory, an alternative foundational theory of well-being, in order to clarify that the outlook of WHO-5 is more a rating system of positive affect than a cognitive judgement of overall life satisfaction. We conclude that it is important to examine the philosophical foundation of rating scales of well-being, such as WHO-5, in order to be fully able to assess the magnitude as well as the limits of their results.
Research objectives. Depression is a very common mental disorder. The Patient Health Questionnaire-9 (PHQ-9) has been frequently used to assess depression in primary healthcare, as well as in research studies. The aim of this study was to assess the Czech version of the PHQ method. Sample and setting. The final study population included 1654 respondents (66,6% of women and 33,4% of men) addressed via social networks within a broader study on motivations for sex. Statistical analysis. The authors calculated the Confirmatory Factor Analysis to assess which of the previously hypothesized factor structures (one-or two-factor solutions) would best fit the data. The authors calculated the Multi Sample Analysis to assess measurement invariance across two translations of the method into Czech. First version was translated by the authors. The second version, which is available online is the Pfizer company translation. The authors further tested the data for gender invariance. Results. The two-factors model suggests the best fit with five ‘somatic’ items and four ‘nonsomatic’ or ‘affective’ items. The model was partially invariant across the two translations. Two items were responsible for non-invariance. The model for version DOMOV was invariant across gender. The model for version Pfizer was partially invariant across gender. One item was responsible for non-invariance. Recommendations are suggested in the discussion. The item analysis indicates that the items are suitable for the scale and the internal consistency of the scale is satisfactory. The correlation between PHQ-9 and BDI-II is consistent with previous findings of a meta-analytic study. The Czech version of PHQ-9 is a useful tool for assessing depression in the general population. Study limitations. Future research should focus on clinical populations. © 2016, Academy of Sciences of the Czech Republic. All rights reserved.
Given that the root mean square error of approximation (RMSEA) is currently one of the most popular measures of goodness-of-model fit within structural equation modeling (SEM), it is important to know how well the RMSEA performs in models with small degrees of freedom (df). Unfortunately, most previous work on the RMSEA and its confidence interval has focused on models with a large df. Building on the work of Chen et al. to examine the impact of small df on the RMSEA, we conducted a theoretical analysis and a Monte Carlo simulation using correctly specified models with varying df and sample size. The results of our investigation indicate that when the cutoff values are used to assess the fit of the properly specified models with small df and small sample size, the RMSEA too often falsely indicates a poor fitting model. We recommend not computing the RMSEA for small df models, especially those with small sample sizes, but rather estimating parameters that were not originally specified in the model.
Zusammenfassung. Befunde aus zwei Studien zur Entwicklung eines Kurzinstruments zur direkten Veränderungsmessung psychotherapeutischer Effekte werden dargestellt. Die Fragebogenkonstruktion fokussiert Veränderungen im Bereich des Befindens. An Studie I waren 150 Patienten von 14 niedergelassenen Psychotherapeuten beteiligt. Sie wurden nach dem Zufall einer Therapie- oder einer Wartelistekontrollgruppe zugewiesen. Nach dreimonatiger Psychotherapie bzw. Wartezeit beantworteten alle den aus zwölf Komparativaussagen bestehenden „Veränderungsfragebogen zum Entspannungserleben und Befinden – Psychotherapie” (VFE-PT). Die Änderungssensivität des Kurzfragebogens für Psychotherapieeffekte wird im Vergleich zur unbehandelten Kontrollgruppe auf Item- und Skalenniveau empirisch bestätigt. Studie II folgt einem naturalistischen Design, nach dem 275 erwachsene ambulante Patienten den VFE-PT 12 bis 20 Wochen nach Therapiebeginn ausgefüllt haben. Die Befunde bestätigen die guten Itemparameter und interne Konsistenz des Verfahrens. Die konvergente Validität des VFE-PT wird durch bedeutsame Korrelationen zu Indikatoren klinisch relevanter Veränderungen aus der indirekten Veränderungsmessung bestätigt.
Theoretischer Hintergrund: Verfahren zur direkten Veränderungsmessung bestimmen den Psychotherapieerfolg in ökonomischer Ein-Punkt-Messung. Hierzu wurde der Bochumer Veränderungsbogen-2000 (BVB-2000) als überarbeitete und gekürzte Variante des Veränderungsfragebogens des Erlebens und Verhaltens (VEV; Zielke & Kopf-Mehnert, 1978) entwickelt. Fragestellung: Der BVB-2000 soll einer testtheoretischen Reanalyse mit Fokus auf die konvergente Validität unterzogen werden. Kritische Veränderungswerte auf Basis der Werte einer klinischen Wartekontrollgruppe sollen die Möglichkeit bieten den Therapieerfolg auch in Einzelfällen zu bestimmen. Methode: Die Psychotherapie von N = 205 Patienten wird mit verschiedenen Instrumenten zur Therapieerfolgsmessung inklusive des BVB-2000 begleitet. Auf Basis einer Wartekontrollgruppe (N = 88) werden kritische Veränderungswerte für den BVB-2000 berechnet. Ergebnisse: Der BVB-2000 weist eine hohe interne Konsistenz auf (α = .96; 26 Items) und zeigt durchgängig statistisch bedeutsame Zusammenhänge mit anderen Therapieerfolgsmaßen vor allem der Zielerreichung. Kritische Veränderungswerte ermöglichen die Einschätzung des Therapieerfolgs im Einzelfall. Schlussfolgerungen: Der BVB-2000 ist ein verständliches, ökonomisches, reliables und valides Instrument zur Psychotherapieerfolgsmessung.
The usual formulas for the reliability of differences between two test scores X and Y are based on the assumption that the error scores EX and EY are uncorrelated. In modern developments of test score theory, such as that of Lord and Novick, a true score is defined as the expected value of an individual's observed score. This definition implies that true scores on any test are uncorrelated with error scores on any test, but it does not imply that error scores on distinct tests X and Y are uncorrelated. A zero correlation between the errors can be obtained only by introducing an additional assumption of "experimental independence" that does not follow from the other axioms in the model. This assumption restricts severely the class of random variables to which the usual formulas for reliability of differences will apply. The present paper investigated the reliability of difference scores in more general cases where it is not assumed that error scores on distinct tests are uncorrelated. The formulas derived are relatively simple, and they reduce to the usual ones of the classical model when EX and EY are uncorrelated.
Recent attempts to reduce internal invalidity in studies employing pretest/posttest self-report in dices of improvement have included the refinement of methodologies employing retrospective reports of pre-treatment states. The present study investigated the operation of social desirability and impression management response bias on such retrospective measures. The results do not support the hypothesis of greater bias on retrospective measurement and, in fact, are in a direction that might suggest an in terpretation of reduced bias on such measures. The results also continue to support superior validity of retrospective over traditional pretest/posttest in dices of improvement following treatment.
Two Monte Carlo studies were conducted to examine the sensitivity of goodness of fit indexes to lack of measurement invariance at 3 commonly tested levels: factor loadings, intercepts, and residual variances. Standardized root mean square residual (SRMR) appears to be more sensitive to lack of invariance in factor loadings than in intercepts or residual variances. Comparative fit index (CFI) and root mean square error of approximation (RMSEA) appear to be equally sensitive to all 3 types of lack of invariance. The most intriguing finding is that changes in fit statistics are affected by the interaction between the pattern of invariance and the proportion of invariant items: when the pattern of lack of invariance is uniform, the relation is nonmonotonic, whereas when the pattern of lack of invariance is mixed, the relation is monotonic. Unequal sample sizes affect changes across all 3 levels of invariance: Changes are bigger when sample sizes are equal rather than when they are unequal. Cutoff points for testing invariance at different levels are recommended.
Psychotherapy denotes a healing that occurs via mental means. Psychological therapy, in contrast, means healing by using psychologically based procedures. This book deals with explanations of how mental processes can be influenced in a therapeutic manner. These explanations are rooted firmly in scientific psychology. The psychological explanations developed herein contain ideas for how mental processes can be influenced most effectively. The psychological understanding of the psychotherapeutic process developed in this book yields specific suggestions for maximizing therapeutic effectiveness. This book is a dialogue among a practicing therapist, a psychotherapy researcher, and a basic research psychologist exploring the idea of a psychologically based psychotherapy. Each participant leads the discussion in one of the following three dialogues, which deals with his or her specific area of competence: (1) how does psychotherapy achieve its effects? (2) toward a psychological understanding of how psychotherapy works, or foundations of psychological therapy; and (3) a psychological model of psychotherapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The pursuit of happiness is an important goal for many people. However, surprisingly little scientific research has focused on the question of how happiness can be increased and then sustained, probably because of pessimism engendered by the concepts of genetic determinism and hedonic adaptation. Nevertheless, emerging sources of optimism exist regarding the possibility of permanent increases in happiness. Drawing on the past well-being literature, the authors propose that a person's chronic happiness level is governed by 3 major factors: a genetically determined set point for happiness, happiness-relevant circumstantial factors, and happiness-relevant activities and practices. The authors then consider adaptation and dynamic processes to show why the activity category offers the best opportunities for sustainably increasing happiness. Finally, existing research is discussed in support of the model, including 2 preliminary happiness-increasing interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background: The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire that proved valid in primary care. However, the GAD-7 was not yet validated in the general population and thus far, normative data are not available.
Objectives: To investigate reliability, construct validity, and factorial validity of the GAD-7 in the general population and to generate normative data.
Research Design: Nationally representative face-to-face household survey conducted in Germany between May 5 and June 8, 2006.
Subjects: Five thousand thirty subjects (53.6% female) with a mean age (SD) of 48.4 (18.0) years.
Measures: The survey questionnaire included the GAD-7, the 2-item depression module from the Patient Health Questionnaire (PHQ-2), the Rosenberg Self-Esteem Scale, and demographic characteristics.
Results: Confirmatory factor analyses substantiated the 1-dimensional structure of the GAD-7 and its factorial invariance for gender and age. Internal consistency was identical across all subgroups (α = 0.89). Intercorrelations with the PHQ-2 and the Rosenberg Self-Esteem Scale were r = 0.64 (P < 0.001) and r = -0.43 (P < 0.001), respectively. As expected, women had significantly higher mean (SD) GAD-7 anxiety scores compared with men [3.2 (3.5) vs. 2.7 (3.2); P < 0.001]. Normative data for the GAD-7 were generated for both genders and different age levels. Approximately 5% of subjects had GAD-7 scores of 10 or greater, and 1% had GAD-7 scores of 15 or greater.
Conclusions: Evidence supports reliability and validity of the GAD-7 as a measure of anxiety in the general population. The normative data provided in this study can be used to compare a subject's GAD-7 score with those determined from a general population reference group.
This study investigated the interrelationships among global self-concept, life events, and positive subjective well-being (positive affect [PA], negative affect [NA], and life satisfaction [LS]) in a sample of 92 high school students. The results demonstrated that life events contributed significant variance to predictions of PA, NA, and LS, over and above that of global self-concept. Also, daily events contributed variance over and above that of major life events. Looking at the specific event types that related uniquely to the positive well-being measures, only negative daily events related significantly to PA and NA, and only positive daily events related significantly to LS. The results also indicated that the positive well-being constructs each contained unique variance and had different correlates, thus providing strong support for the multidimensionality of adolescent positive well-being reports. Implications for further research and intervention programs are discussed. © 2000 John Wiley & Sons, Inc.
OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity.
MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients.
RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples.
CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and Gamma Hat; a cutoff value close to .90 for Mc; a cutoff value close to .08 for SRMR; and a cutoff value close to .06 for RMSEA are needed before we can conclude that there is a relatively good fit between the hypothesized model and the observed data. Furthermore, the 2‐index presentation strategy is required to reject reasonable proportions of various types of true‐population and misspecified models. Finally, using the proposed cutoff criteria, the ML‐based TLI, Mc, and RMSEA tend to overreject true‐population models at small sample size and thus are less preferable when sample size is small.
The standard error of measurement (SEM) is the standard deviation of errors of measurement that are associated with test scores from a particular group of examinees. When used to calculate confidence bands around obtained test scores, it can be helpful in expressing the unreliability of individual test scores in an understandable way. Score bands can also be used to interpret intraindividual and interindividual score differences. Interpreters should be wary of over-interpretation when using approximations for correctly calculated score bands. It is recommended that SEMs at various score levels be used in calculating score bands rather than a single SEM value.
Results of two studies on the construction of a brief questionnaire for the direct measurement of psychotherapeutic outcomes are presented. Test construction follows the theory of change in integrative, differential psychotherapy. Items focus on changes in behavior and experience with reference to increases in self-efficacy and improved coping in patients. Study 1 included 150 outpatients of 14 psychotherapists. Controlling for diagnosis, gender, and age, patients were randomized to a therapy group (n = 75) or a waiting-list control group (n = 75). After three months of waiting or psychotherapy, all subjects completed the “Questionnaire of Personal Changes” consisting of 12 temporal comparatively formulated items. Group comparisons indicate the change sensitivity of the items and the scale score for psychotherapeutic effects. Study 2 followed a naturalistic design including 275 psychotherapy outpatients who completed the questionnaire 14-20 weeks after start of therapy. Results confirm acceptable psychometric properties of the scale with reference to item parameters and reliability. Convergent validity of the scale score is empirically supported by significant correlations to clinically relevant indicators of psychotherapeutic outcomes from indirect measurements of change.
The health status questionnaire Short‐Form 36 (SF‐36) includes subscales measuring both physical health and mental health. Psychometrically, the mental health subscale contains a mixture of mental symptoms and psychological well‐being items, among other things, to prevent a ceiling effect when used in general population studies. Three of the mental health well‐being items are also included in the WHO‐Five well‐being scale. In a Danish general population study, the mental health subscale was compared psychometrically with the WHO‐Five in order to evaluate the ceiling effect. Tests for unidimensionality were used in the psychometric analyses, and the sensitivity of the scales in differentiating between changes in self‐reported health over the past year has been tested.
The results of the study on 9,542 respondents showed that, although the WHO‐Five and the mental health subscale were found to be unidimensional, the WHO‐Five had a significantly lower ceiling effect than the mental health subscale. The analysis identified the three depression symptoms in the mental health subscale as responsible for the ceiling effect. The WHO‐Five was also found to be significantly superior to the mental health subscale in terms of its sensitivity in differentiating between those persons whose health had deteriorated over the past year and those whose health had not.
In conclusion, the WHO‐Five, which measures psychological well‐being, reflects aspects other than just the absence of depressive symptoms. Copyright © 2003 Whurr Publishers Ltd.
In 2 studies, clients were asked, after terminating psychotherapy, to complete a measure of symptomatic distress exactly as they had in their pre-therapy assessment. Most clients overestimated their pre-therapy distress, which may lead to an illusion of positive change. A 3rd study found no overestimation of previously reported distress in a control sample. The degree of overestimation for psychotherapy clients was positively correlated with anxiety, depression, and neuroticism, and negatively correlated with ego strength, self-deception, and lying. Distress levels at termination mediated these effects of individual differences. Individual differences were also correlated with specific types of recall error, such as adding to, exaggerating, omitting, and minimizing previously reported symptoms. Misremembering prior emotions may both reflect and create individual differences.
Practice-based evidence - findings from routine clinical settings
- L G Castonguay
- M Barkham
- S J Youn
- A C Page
- Castonguay L. G.
Castonguay, L. G., Barkham, M., Youn, S. J., & Page, A. C.
(2021). Practice-based evidence -findings from routine clinical
settings. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.),
Bergin and Garffield's handbook of psychotherapy and behavior
change (7th ed., pp. 191-222). Wiley.
semTools: Useful tools for structural equation modeling
- T D Jorgensen
- S Pornprasertmanit
- A M Schoemann
- Y Rosseel
Jorgensen, T. D., Pornprasertmanit, S., Schoemann, A. M., &
Rosseel, Y. (2022). semTools: Useful tools for structural equation
modeling. R package version 0.5-6. https://CRAN.R-project.
org/package = semTools.