Outpatient Psychotherapy Research Articles

Psychotherapists' perspectives on collaboration and stepped care in outpatient psychotherapy - A qualitative study

Social functioning is an important component of mental disorders for assessment and treatment. There is no recognised self-report instrument to measure social functioning across disorders where social impairment is significant. The Social Functioning Scale (SFS) has, however, been used to assess social functioning in psychotic disorders, including Schizophrenia and Early Psychosis. The current study investigated the reliability, validity and sensitivity of the SFS in Early Psychosis, Autism Spectrum Disorder (ASD), Social Anxiety Disorder (SAD) and neurotypical control populations. As expected, all clinical groups showed significant impairment on the total and sub-scale scores of the SFS. The SFS showed good internal consistency and concurrent validity for people diagnosed with SAD and Early Psychosis and a similar factors structure was found for these groups. Participants with ASD reported a relatively low internal consistency and poor concurrent validity, as well as a three-component solution. The SFS has also showed a good sensitivity to separate clinical populations and neurotypical controls. This study supports the use of the SFS for those with SAD and Early Psychosis. Lower internal consistency in ASD populations suggests further research in larger samples is required and that the relationship between its scales are likely different to other populations. Alternative scales or significant other reports may be required for adults with ASD.

Intervention training using peer role‐play and standardised patients in psychodynamic psychotherapy trainees

AbstractBackgroundInnovative teaching models promoting beneficial therapist behaviour are central to the improvement of psychotherapeutic practice. This study investigated the effects of peer role‐play (RP) and standardised patients (SP) in the context of an intervention skill training course during psychodynamic psychotherapy training.MethodsIn a mixed‐method approach, effects of intervention training with RP and SP on trainees’ self‐efficacy and intervention use during treatment were investigated using trainees’ self‐report questionnaires, qualitative interviews and psychotherapy session observer ratings. Twenty graduate psychotherapy students (17 female; mean age 36 years) participated in an intervention skill seminar. We assessed subjective ratings of intervention competence before and after training as well as acceptance of the training format. For a subsample of 11 participants, we examined changes in frequency and competency of intervention use with session‐based observer ratings during their current outpatient treatments. Furthermore, 10 participants reflected on their training experiences in open interviews, evaluated using inductive content analysis.FindingsThe trainees’ self‐efficacy for the trained interventions increased significantly after training. The training was well accepted and subjectively associated with learning success. Training transfer effects were observed regarding higher frequency and competence in the domain of clarifying and mirroring interventions during participants’ outpatient psychotherapy sessions. Qualitative analysis showed training effects for self‐reflection regarding intervention use, while also promoting the development of therapeutic self‐understanding.ConclusionOur findings provide further evidence that RP and SP training can assist the development of psychotherapy skills. Hence, the regular implementation of RP and SP training during graduate psychotherapy training seems feasible.

Voluntariness in Outpatient Psychotherapy with Children and Adolescents

Voluntariness in Outpatient Psychotherapy with Children and Adolescents Voluntariness is no selective construct in psychotherapy with children and adolescents. Generally psychotherapy is utilized under external pressure, at least partially. At any rate it is crucial to painstakingly analyze the motivation for change and possible obstacles to motivation. On that basis different strategies to foster motivation for change can be applied. Problems regarding the efficiency of voluntary or involuntary utilization of outpatient psychotherapy for children and adolescents should be subjects to further research.

Trends in Treatment and Spending for Patients Receiving Outpatient Treatment of Depression in the United States, 1998-2015

After marked increases from 1987 to 1997, trends in depression treatment in the United States increased modestly from 1998 to 2007. However, multiple policy changes that expanded insurance coverage for mental health conditions may have shifted these trends again since 2007. To examine national trends in outpatient treatment of depression from 1998 to 2015, with particular focus on 2007 to 2015. This analysis of the use of health services and spending for treatment of depression in the United States assessed data from the 1998 (n = 22 953), 2007 (n = 29 370), and 2015 (n = 33 893) Medical Expenditure Panel Surveys (MEPSs). Participants included respondent households to the nationally representative survey. Data were analyzed from June 15 through December 18, 2018. Rates of outpatient and pharmaceutical treatment of depression; counts of outpatient visits, psychotherapy visits, and prescriptions; and expenditures. The analysis included 86 216 individuals from the 1998, 2007, and 2015 MEPSs. Respondents' mean (SD) age was 37.2 (22.7) years; 45 086 (52.3%) were female, 24 312 (28.2%) were Hispanic, 15 463 (17.9%) were black, and 62 926 (72.9%) were white. Rates of outpatient treatment of depression increased from 2.36 (95% CI, 2.12-2.61) per 100 population in 1998 to 3.47 (95% CI, 3.16-3.79) per 100 population in 2015. The proportion of respondents who were treated for depression using psychotherapy decreased from 53.7% (95% CI, 48.3%-59.1%) in 1998 to 43.2% (95% CI, 39.0%-47.4%) in 2007 and then increased to 50.4% (95% CI, 46.0%-54.9%) in 2015, whereas the proportion receiving pharmacotherapy remained steady at 81.9% (95% CI, 77.9%-85.9%) in 1998, 82.4% (95% CI, 79.3%-85.4%) in 2007, and 80.8% (95% CI, 77.9%-83.7%) in 2015. After adjusting for inflation using 2015 US dollars, prescription expenditures for these individuals decreased from $848 (95% CI, $713-$984) per year in 1998 to $603 (95% CI, $484-$722) per year in 2015, whereas the mean number of prescriptions decreased from 7.64 (95% CI, 6.61-8.67) in 1998 to 7.03 (95% CI, 6.51-7.56) in 2015. National expenditures for outpatient treatment of depression increased from $12 430 000 000 in 1997 to $15 554 000 000 in 2007 and then to $17 404 000 000 in 2015, consistent with a slowing growth in national outpatient expenditures for depression. The percentage of this spending that came from self-pay (uninsured) individuals decreased from 32% in 1998 to 29% in 2007 and then to 20% in 2015. This decrease was largely associated with increasing Medicaid coverage, because the percentage of this spending covered was 19% in 1998, 15% in 2007, and 36% in 2015. Recent policy changes that increased insurance coverage for depression may be associated with reduced uninsured burden and with modest increases in the prevalence of and overall spending for outpatient treatment of depression. The lower-than-expected rate of treatment suggests that substantial barriers remain to individuals receiving treatment for their depression.

Group body psychotherapy for the treatment of somatoform disorder - a partly randomised-controlled feasibility pilot study

BackgroundClinical outcomes for patients with heterogeneous somatoform disorder (bodily distress disorder, including medically unexplained symptoms) are suboptimal, new treatments are required to improve acceptance. Body-oriented psychological therapy approaches have been identified as potentially beneficial additions to the portfolio of treatments. This study was aiming to assess the acceptability, the potential benefits, and associated change processes of manualised group body psychotherapy (BPT) for outpatients with Somatoform Disorder.MethodsA randomized controlled feasibility trial was carried out with follow-up at 6 months after baseline assessments using the Primary Health Questionnaire (PHQ), Somatic Symptom Screening Scale (SOMS-7), quality of life ratings (Short-Form Health Survey-36; SF-36) and body image measures (Dresden Body Image Questionnaire). Acceptance was assessed with the Helping Alliance Scale (HAS).ResultsA total of 24 patients were recruited to participate. Sixteen patients were randomly assigned to receive either manualised BPT or TAU, eight patients were directly assigned to BPT. Drop-out rates were acceptable, patients reported to be highly satisfied with the group intervention. Somatic symptom levels reduced significantly in the BPT group. Additionally, a significant effect on self-acceptance and the mental component of quality of life was observed.ConclusionGroup body psychotherapy is a feasible and acceptable treatment for patients with somatoform disorder and a larger trial studying the effectiveness of BPT in these patients should be conducted.Trial registrationRetrospectively registered SRCTN12277345; Trial Registraton Date: 27/03/2019.

New Media in Psychotherapy: Blended Therapy from the Perspective of Outpatient Psychotherapists

The aim of the study was to generate a model describing psychotherapists' use of new media in outpatient psychotherapy. Problem-centered interviews were conducted with 12 outpatient psychotherapists. Data was analyzed following the Grounded Theory approach. The interviews revealed five categories that were integrated into the model "Use of new media in outpatient therapy" (MAP): First, psychotherapists' characteristics determine whether new media use is considered. When new media is in use, patient characteristics define its intensity and content. Additionally, decision making rules and communication rules shape therapists' use of new media. MAP identifies barriers and facilitators of new media application in outpatient psychotherapy and describes psychotherapists' decision making process. Options for implementing blended therapy in outpatient psychotherapeutic care are discussed.

Integrating structure and dynamics in personality assessment: First steps toward the development and validation of a personality dynamics diary.

Both theories and cutting-edge research highlight the dynamic nature of personality and personality pathology, thereby posing significant challenges for an exclusively between-person, trait-based approach to personality assessment. In a series of 3 studies, we explored the viability of integrating within-person, dynamic aspects into clinical personality assessment by means of daily dairy methods. In the 1st study, 314 students filled out a 73-item questionnaire capturing daily behaviors and situation experiences across 7-10 consecutive days. We used multilevel exploratory factor analyses to construct a shortened version, the Personality Dynamics Diary (PDD). In the 2nd study, the PDD was applied in a sample of 77 psychotherapy inpatients across 40 days, on average. In the 3rd study, 35 psychotherapy outpatients as well as their therapists judged the clinical utility of a smartphone version of the PDD. Taken together, we were able to construct a relatively brief self-report measure that assesses major dimensions of within- and between-person differences of situations and behaviors in daily life with acceptable reliability. Application in clinical samples provided further evidence for the reliability, validity, and clinical utility of the PDD but also highlighted possible obstacles in clinical practice as well as the need for further replication and refinement. We conclude that daily diary methods have the potential to integrate within- and between-person approaches to personality assessment. By applying measures like the PDD, clinicians may gain insight into the psychological mechanisms that give rise to, and maintain, a person's maladaptive dispositions and ultimately find individualized leverage points for targeted therapeutic interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Effectiveness of Psychoanalytic Psychotherapy for Children and Adolescents with Severe Anxiety Psychopathology in a Naturalistic Treatment Setting

Effectiveness of Psychoanalytic Psychotherapy for Children and Adolescents with Severe Anxiety Psychopathology in a Naturalistic Treatment Setting The aim of the study was to evaluate naturalistic out-patient psychoanalytic youth psychotherapy in Germany. The study was a partly controlled effectiveness trial. While the first treatment interval (25 sessions, 6.13 months) was compared with a wait-list control group (5 supportive sessions, 2.94 months), the effects of long-term psychoanalytical treatment were analyzed using a time-series design. 86 children and adolescents (aged 4 to 21 years) and their parents who entered psychoanalytic therapy in private practices participated in this study. The wait-list control group comprised 35 patients. Questionnaires were administered at the beginning and the end of treatment, as well as 6 and 12 month follow-up (FU). Patients received on average 94.04 therapy sessions (range 8 to 300) over 25.70 months. Data analyses were carried out with multilevel mixed linear models on the intention-to-treat (ITT) sample. The patients in the intervention group reported moderate symptom improvements at the end of therapy (d = .57), these effects are stable at the 1-year follow-up and increase from the patient perspective (d = .80). When comparing the first therapy interval with the (minimal treatment) wait-list control group, both groups improved significantly with small effect sizes and no significant group differences. The results suggest that long-term psychoanalytic therapy is successful in alleviating anxiety pathology and improving quality of life for youth with anxiety disorders, and that improvements remain stable across a 1-year follow-up period.

A research programme to evaluate DBT-PTSD, a modular treatment approach for Complex PTSD after childhood abuse

BackgroundPosttraumatic stress disorder (PTSD) after childhood abuse (CA) is often related to severe co-occurring psychopathology, such as symptoms of borderline personality disorder (BPD). The ICD-11 has included Complex PTSD as a new diagnosis, which is defined by PTSD symptoms plus disturbances in emotion regulation, self-concept, and interpersonal relationships. Unfortunately, the empirical database on psychosocial treatments for survivors of CA is quite limited. Furthermore, the few existing studies often have either excluded subjects with self-harm behaviour and suicidal ideation — which is common behaviour in subjects suffering from Complex PTSD. Thus, researchers are still trying to identify efficacious treatment programmes for this group of patients.We have designed DBT-PTSD to meet the specific needs of patients with Complex PTSD. The treatment programme is based on the rules and principles of dialectical behavioural therapy (DBT), and adds interventions derived from cognitive behavioural therapy, acceptance and commitment therapy and compassion-focused therapy. DBT-PTSD can be provided as a comprehensive residential programme or as an outpatient programme. The effects of the residential programme were evaluated in a randomised controlled trial. Data revealed significant reduction of posttraumatic symptoms, with large between-group effect sizes when compared to a treatment-as-usual wait list condition (Cohen’s d = 1.5).The first aim of this project on hand is to evaluate the efficacy of the outpatient DBT-PTSD programme. The second aim is to identify the major therapeutic variables mediating treatment efficacy. The third aim is to study neural mechanisms and treatment sensitivity of two frequent sequelae of PTSD after CA: intrusions and dissociation.MethodsTo address these questions, we include female patients who experienced CA and who fulfil DSM-5 criteria for PTSD plus borderline features, including criteria for severe emotion dysregulation. The study is funded by the German Federal Ministry of Education and Research, and started in 2014. Participants are randomised to outpatient psychotherapy with either DBT-PTSD or Cognitive Processing Therapy. Formal power analysis revealed a minimum of 180 patients to be recruited. The primary outcome is the change on the Clinician-Administered PTSD Scale for DSM-5.DiscussionThe expected results will be a major step forward in establishing empirically supported psychological treatments for survivors of CA suffering from Complex PTSD.Trial registrationGerman Clinical Trials Register: registration number DRKS00005578, date of registration 19 December 2013.

Getting unstuck: Dialectical strategies to reduce suffering and build a life worth living

Case: Katharina is a 16‐year‐old female referred for adolescent dialectical behavior therapy (DBT‐A) following her second psychiatric hospitalization for suicidal intent and plan. She presents with chronic suicidal ideation, frequent nonsuicidal self‐injury, severe hopelessness and worthlessness, and recent academic decline. Katharina's life‐threatening behaviors emerged last year in the context of worsening depression, anxiety, irritability, disordered eating, and increased familial conflict, particularly around limit setting. Her pervasive and severe emotion dysregulation had not improved following outpatient psychotherapy with multiple cognitive behavioral therapists, pharmacotherapy, and inpatient and partial hospitalizations.

The dose-response effect in routinely delivered psychological therapies: A systematic review

The dose-response effect refers to the relationship between the dose (e.g., length, frequency) of treatment and the subsequent probability of improvement. This systematic review aimed to synthesize the literature on the dose-response effect in routine psychological therapies delivered to adult patients with mental health problems. Twenty-six studies were eligible for inclusion. Different methodological approaches have been used to examine the dose-response effect; including survival analysis, multilevel modelling and descriptive cluster analyses. Replicated and consistent support was found for a curvilinear (log-linear or cubic) relationship between treatment length and outcomes, with few exceptions such as eating disorders and severe psychiatric populations. Optimal doses of psychotherapy in routine settings range between 4 and 26 sessions (4–6 for low intensity guided self-help) and vary according to setting, clinical population and outcome measures. Weekly therapy appears to accelerate the rate of improvement compared to less frequent schedules. Most of the reviewed evidence is from university counselling centres and outpatient psychotherapy clinics for common mental health problems. There is scarce and inconclusive evidence in clinical samples with chronic and severe mental disorders.

Social anxiety disorder and avoidant personality disorder from an interpersonal perspective.

The general objective of this article is to study the unclear and overlapping relationship between social anxiety disorder (SAD) and avoidant personality disorder (AvPD) from an interpersonal perspective. The first specific objective is to compare the disorders with regard to interpersonal problems and general symptom distress. The second specific objective is to examine interpersonal subgroups and pathoplasticity. In a cross-sectional design, patients from an outpatient psychotherapy clinic diagnosed with social anxiety disorder (SAD, n=299), avoidant personality disorder (AvPD, n=180), or the comorbid condition of both disorders (AvPD+SAD, n=29) were assessed before treatment. Patients filled out the Inventory of Interpersonal Problems (IIP-64) and the Symptom Checklist-Revised (SCL-R-90) before treatment. From an interpersonal perspective, the relationship between the diagnostic groups is well described by the severity continuum hypothesis, with similar interpersonal problems related to Nonassertiveness and lower levels of general interpersonal stress in the SAD group compared to the two AvPD groups. However, other differences in severity do not fit the severity continuum hypothesis, as there are no differences in severity on the global severity index, and, moreover, the SAD group has the most severe problems on the SCL-90 phobic anxiety scale. Interpersonal pathoplasticity is not found in the diagnostic groups or in the full sample. However, three interpersonal subgroups are identified in the full sample, designated as Nonassertive, Friendly-submissive, and Cold-submissive. Implications for treatment are discussed. SAD is characterized by a lower level of interpersonal distress compared to AvPD, but the two disorders are similar in having Nonassertiveness as their general interpersonal problem. Contrary to expectation, SAD and AvPD did not differ in general level of symptom severity, and patients with SAD reported more problems with phobic anxiety than AvPD patients did. When understanding SAD and AvPD as different conceptualizations of the same disorder and analysing all patients together, three distinct interpersonal subgroups emerge, which can be identified as Nonassertive, Friendly-submissive, and Cold-submissive.

Therapeutic alliance, cultural competence and minority status in premature termination of psychotherapy.

Premature termination is a pervasive barrier to effective implementation of outpatient psychotherapy that frequently results in poorer outcomes for clients as well as poor resource allocation for clients, therapists, and society. Despite its high prevalence and cost, premature termination remains poorly understood, especially from the clients' perspective. The current study addressed some gaps in the literature using a national online survey design that permitted investigation of a broad range of potential predictors of premature termination. Participants were 278 respondents from Amazon.com's Mechanical Turk who completed an online survey about their treatment history, their most recent outpatient therapy experience and therapist, termination status, reasons for terminating prematurely (if applicable), treatment satisfaction, and demographics. Results indicated that being a woman, identifying as a sexual minority, and having a therapist low in perceived multicultural competence were associated with increased risk of premature termination. However, the best predictors of premature termination were a weak therapeutic alliance and symptoms of depression. These results support previous research that shows both client and therapist variables contribute to premature termination. Potential interventions that can be implemented by providers or agencies to reduce premature termination are discussed, along with limitations of the study and recommendations for future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Нарушения проспективной способности как возможный патогенетический механизм алкогольной зависимости

The article presents a taxonomy of prospective capacity (PC) relying on the up-to-date understanding of its neurobiological and psychological mechanisms. The rationale for the existence of a dissociation between adaptive and maladaptive manifestations of explicit and implicit forms of PC rests on a study of clinical cases of alcohol-dependent patients (N=5) and adult children of alcoholics (N=1), who ap plied for outpatient psychotherapy of alcohol dependence or related issues. The patients underwent specific semi-structured interviews (Shustov et al., 2000; Johnsson, 2011); completed the Life Line method (Nurkova, 2000) and compiled genograms (McGoldrick et al, 2008). Based on the findings of clinical case studies, the authors have proposed that alcohol-dependent patients’ PC deficits that aggravate the course of alcohol dependence may relate to the existence of socially and culturally bound automatic prospective schemata, i.e. scripts that relate to specific states of self and actualize under uncertainty, stress and/or alcohol intoxication.

Depression predicts interpersonal problems partially through the attitude towards social touch.

Depression is associated with difficulties in interpersonal relationships, of which communication is an integral part. Communication can not only be effected by verbal means, but also non-verbally by touch. Against this background, the aim of the present study was to investigate the relationship between depression, interpersonal problems and the attitude towards social touch. 147 individuals (115 females; 21-71 years old) seeking treatment in a clinic for outpatient psychotherapy took part in the survey. Three questionnaires evaluating the level of depression (Beck Depression Questionnaire), the degree of interpersonal problems (Inventory of Interpersonal Problems) and the attitude towards social touch (Social Touch Questionnaire, were administered. Highly depressed individuals had a more negative attitude towards social touch than non-to lowly depressed individuals. Highly depressed individuals particularly reported to dislike physical touch by not well-known people, but not by close ones. Highly depressed individuals also reported more interpersonal problems, with the level of depression predicting the degree of interpersonal problems. This relationship was partially mediated by the attitude towards social touch in general and, to a greater extent, by the dislike of physical touch by people not well-known in particular. Given the role of social touch in the relationship between depression and interpersonal problems, the attitude towards touch may be taken into consideration in the therapy of depressed patients. We assume that a more positive attitude towards social touch can influence the ability to create and maintain interpersonal relationships.

Outpatient Psychotherapy for Adults with High-Functioning Autism Spectrum Condition: Utilization, Treatment Satisfaction, and Preferred Modifications

Many adults with autism spectrum condition (ASC) desire outpatient psychotherapy (PT). This study compared reasons for seeking PT, experiences with PT, and modifications preferred with respect to PT of individuals with ASC to non-autistic individuals with depression (MDD). Furthermore, factors predictive for treatment satisfaction were identified in individuals with ASC. A total of 262 adults with ASC without intellectual impairment and 304 non-autistic controls with MDD were surveyed. In this pilot study both groups predominantly sought treatment for depressiveness. A low level of expertise with autism was the main reason for being declined by therapists and a contributing factor to the overall treatment dissatisfaction of patients with ASC. ASC patients desire adjustments such as written communication, and clearly structured sessions.

Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders

ObjectiveThis study aimed to examine whether the Unified Protocol (UP), a transdiagnostic cognitive-behavioral therapy for emotional disorders (i.e., anxiety, mood, and related disorders), is efficacious in the treatment of co-occurring emotional disorders compared to established single disorder protocols (SDPs) that target specific disorders (e.g., panic disorder). MethodParticipants included 179 adults seeking outpatient psychotherapy. Participant age ranged from 18 to 66 years, with an average of 30.66 years (SD = 10.77). The sample was 55% female and mostly Caucasian (83%). Diagnostic assessments were completed with the Anxiety Disorder Interview Schedule (ADIS), and disorder-specific, clinician-rated measures for the comorbid diagnoses of interest. ResultsIn both treatment conditions, participants' mean number of diagnoses dropped significantly from baseline to posttreatment, and baseline to 12-month follow-up. Additionally, large effects were observed for changes in comorbid generalized anxiety (ESSG: UP = −1.72; SDP = −1.98), social anxiety (ESSG: UP = −1.33, −0.86; SDP = −1.60, −1.54), and depression (ESSG: UP = −0.83; SDP = −0.84). Significant differences were not observed in between-group comparisons. ConclusionsResults suggest that both the UP and SDPs are efficacious in reducing symptoms of comorbid emotional disorders. The clinical, practical, and cost-effective advantages of transdiagnostic CBT are discussed.

Brief strategic therapy and cognitive behavioral therapy for women with binge eating disorder and comorbid obesity: A randomized clinical trial one-year follow-up.

Binge eating disorder (BED) is frequently linked with obesity and related health risks like cardiovascular disease and diabetes. The purpose of this randomized clinical trial (RCT) was to determine the effectiveness of brief strategic therapy (BST) compared with cognitive-behavioral therapy (CBT) 1 year after a two-phase inpatient and outpatient-telemedicine treatment for BED. Italian women with BED and comorbid obesity were recruited from a self-referred inpatient treatment program for weight loss (N = 60) and randomly assigned to either the BST treatment condition (n = 30) or CBT treatment condition (n = 30). Inpatient psychotherapy sessions were conducted in person and outpatient telemedicine psychotherapy sessions were conducted over the telephone. Multilevel growth curve modeling was used to estimate average growth trajectories from baseline to 1 year after treatment for the following outcomes: binge eating frequency, weight, and global functioning. One year after treatment, women in the BST condition decreased in binge eating frequency and women in the CBT condition did not, whereas women in both conditions improved in weight and global functioning. BST was statistically and clinically superior to CBT in improving binge eating frequency, weight, and global functioning. Examining BED, given the current obesity epidemic, is an important area of study. Findings suggest that BST is statistically and clinically more effective than CBT in treating BED, promoting weight loss, and improving global functioning among women with BED and comorbid obesity 1 year after treatment. Telemedicine may be instrumental in reducing attrition. (PsycINFO Database Record

Are we overdosing treatment? Secondary findings from a study following women with bulimia nervosa after inpatient treatment.

Provision of eating disorder (ED) treatment in practice is often guided by national health service structures rather than evidence-based treatment recommendations. Especially for more severely or chronically ill patients, clinicians seem to advocate a "the more the better" strategy of treatment provision. Exploring the dose-response relationship in ED treatment may shed light on both beneficial and detrimental effects of prolonged treatment provision. We utilized data from 64 women from the treatment-as-usual (TAU) group of a randomized controlled trial on Internet-based aftercare for women with bulimia nervosa who had received inpatient treatment. We examined the relationship between treatment duration and dose and (1) baseline patient characteristics and (2) treatment outcomes (abstinence from binge eating and compensatory behaviors, frequency of binge eating and vomiting, thin ideal internalization, and general psychopathology) at 18-month follow up. On average, the women in our study were hospitalized for 9 weeks and most received high doses of subsequent outpatient psychotherapy (median: 45 sessions). The severity of symptoms that a patient experienced at hospital admission or discharge was largely unrelated to the amount of outpatient treatment she subsequently received. Longer inpatient treatments or higher doses of subsequent outpatient treatment did not result in more favorable outcomes. Our findings suggest that, instead of providing costly long treatment without evidenced benefit to patients, there is a need for further exploration of and discussion about the risks and benefits of providing high doses of treatment for both individuals and the health care system.

The importance of body image disturbances for the outcome of outpatient psychotherapy in patients with anorexia nervosa: Results of the ANTOP-study.

This study investigates the role of body image self-appraisal in predicting the outcomes of outpatient psychotherapy in patients with anorexia nervosa (AN). Multiple linear regression analyses and a path-analysis model were applied to test the study hypotheses that body image at baseline predicts treatment outcomes of outpatient psychotherapy in patients with AN at follow-up measurement. The analyses were conducted as secondary analyses in a subgroup (n=148) of the anorexia nervosa treatment of outpatient-cohort (ANTOP-study) (N=242) of patients with AN. The results show that Negative Evaluation of the Body at baseline predicts perceived stress during psychotherapy, which in turn predicts depressive symptoms at the end of therapy which in turn predicts the outcomes body mass index and EDI-2 sum score at 12months follow-up. The results underline the importance of body image disturbance in the course of AN and call for body image as a central target of psychotherapeutic interventions in patients with AN.