Preference For Psychotherapy Research Articles

A randomized controlled trial of targeted vs. General direct-to-consumer marketing to address psychotherapy attitudes and stigma in military service members and Veterans

ABSTRACT Many military service members and Veterans who experience a psychological need do not seek psychotherapy, which may be due to negative attitudes and stigma toward mental health services. In this study, we investigated the effectiveness of a general vs. military-specific direct-to-consumer psychotherapy marketing video to address psychotherapy attitudes in a nationwide sample of military service members and Veterans (N = 262). Participants were randomly assigned to watch a general commercial produced by the American Psychological Association (APA Video), a military-specific commercial produced by the Department of Veteran Affairs (VA Video), or a control video. After watching the video, they were asked to complete measures assessing public and self-stigma, attitudes, intentions, and preferences for psychotherapy. Consistent with our hypotheses, participants in the direct-to-consumer marketing conditions reported experiencing significantly less self-stigma and more positive attitudes and preferences for psychotherapy after watching their videos, compared to participants in the control condition. Participants who viewed the APA video also reported significantly less public stigma than those in the control condition. Contrary to our hypotheses, the targeted VA video did not outperform the general APA video on any of the dependent variables. These results support the use of direct-to-consumer psychotherapy marketing videos, general or targeted, with military service members and Veterans. Limitations and future directions are discussed.

The digital cumulative complexity model: a framework for improving engagement in digital mental health interventions.

Mental health disorders affect a substantial portion of the global population. Despite preferences for psychotherapy, access remains limited due to various barriers. Digital mental health interventions (DMHIs) have emerged to increase accessibility, yet engagement and treatment completion rates are concerning. Evidence across healthcare where some degree of self-management is required show that treatment engagement is negatively influenced by contextual complexity. This article examines the non-random factors influencing patient engagement in digital and face-to-face psychological therapies. It reviews established models and introduces an adapted version of the Cumulative Complexity Model (CuCoM) as a framework for understanding engagement in the context of digital mental health. Theoretical models like the Fogg Behavior Model, Persuasive System Design, Self-Determination Theory, and Supportive Accountability aim to explain disengagement. However, none adequately consider these broader contextual factors and their complex interactions with personal characteristics, intervention requirements and technology features. We expand on these models by proposing an application of CuCoM's application in mental health and digital contexts (known as DiCuCoM), focusing on the interplay between patient burden, personal capacity, and treatment demands. Standardized DMHIs often fail to consider individual variations in burden and capacity, leading to engagement variation. DiCuCoM highlights the need for balancing patient workload with capacity to improve engagement. Factors such as life demands, burden of treatment, and personal capacity are examined for their influence on treatment adherence. The article proposes a person-centered approach to treatment, informed by models like CuCoM and Minimally Disruptive Medicine, emphasizing the need for mental healthcare systems to acknowledge and address the unique burdens and capacities of individuals. Strategies for enhancing engagement include assessing personal capacity, reducing treatment burden, and utilizing technology to predict and respond to disengagement. New interventions informed by such models could lead to better engagement and ultimately better outcomes.

The acceptability of lifestyle medicine for the treatment of mental illness: perspectives of people with and without lived experience of mental illness

ObjectiveWhile lifestyle medicine can be highly effective for treating a range of mental illnesses these approaches are grossly underutilised and have not been systematically implemented into health care systems. Understanding the acceptability of lifestyle medicine is a critical first step to remediate this. This study evaluated the acceptability of lifestyle medicine relative to pharmacotherapy and psychotherapy, and explore perspectives of people with and without lived experience of mental illness.MethodsSix hundred and forty-nine adult Australian residents (62.6% female; 53.6% with a lifetime diagnosis of mental illness) completed an online survey based on the Theoretical Framework of Acceptability assessing the acceptability of lifestyle medicine, pharmacotherapy and psychotherapy for treating mental illness.ResultsMost participants felt positive about lifestyle medicine (76.9%) and felt that such approaches aligned with their personal values (74.9%). They understood how lifestyle medicine worked (86.4%) and believed it would be effective (69.6%). Lived experience of mental illness was associated with greater perceived burden and lower self-efficacy to engage in lifestyle medicine activities (both p < 0.001). While there was a clear preference for psychotherapy and lifestyle medicine over pharmacotherapy, pharmacotherapy was perceived as least effortful (p < .001) and participants were least confident in their ability to engage in lifestyle medicine (p < 0.05).ConclusionThe findings indicate strong acceptability of lifestyle medicine for mental illness, a preference for non-pharmacological treatment approaches, and an understanding of the challenges associated with making long-term healthy lifestyle modifications amongst people who have lived experience of mental illness.

Validation of the Cooper–Norcross Inventory of Preferences (C-NIP) in Chinese lay clients and mental health professionals: Factor structure, measurement invariance, and scale differences.

The Cooper-Norcross Inventory of Preferences (C-NIP) is one of the most widely used measures of psychotherapy preferences. However, its psychometric properties have not been examined in non-Western samples. Research on disparities between the preferences of mental health professionals and their clients is also limited. We evaluated the C-NIP's psychometric properties and measurement invariance in Chinese lay clients and mental health professionals and evaluated the latent mean differences between clients' and professionals' scores on the C-NIP's four scales (preference for therapist vs. client directiveness, emotional intensity vs. emotional reserve, past vs. present orientation, and warm support vs. focused challenge). This cross-sectional investigation involved 301 lay clients and 856 mental health professionals who completed the Chinese version of the C-NIP. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to examine the factor structure of the C-NIP. ESEM provided stronger evidence than CFA for the four-factor model in both samples. The four scales had adequate internal consistency in both the lay clients (αs = .68-.89) and the mental health professionals (αs = .70-.80). Partial scalar invariance was established across these two populations. Chinese mental health professionals preferred less therapist directiveness, past orientation, and warm support-but more emotional intensity-than Chinese lay clients (ds = 0.25-0.90). Culture-specific cutoff values (norms) to identify strong therapy preferences were established. This study supports the application of the C-NIP to non-Western populations and suggests that discrepancies between the preferences of lay clients and mental health professionals are a cross-cultural phenomenon. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Differences in psychotherapy preferences between psychotherapy trainees and laypeople

Objective: Despite increasing research on psychotherapy preferences, the preferences of psychotherapy trainees are largely unknown. Moreover, differences in preferences between trainees and their patients could (a) hinder symptom improvement and therapy success for patients and (b) represent significant obstacles in the early career and development of future therapists. Method: We compared the preferences of n = 466 psychotherapy trainees to those of n = 969 laypersons using the Cooper-Norcross Inventory of Preferences. Moreover, we compared preferences between trainees in cognitive–behavioural therapy (CBT) and psychodynamic trainees. Results: We found significant differences between both samples in 13 of 18 items, and three of four subscales. Psychotherapy trainees preferred less therapist directiveness (d = 0.58), more emotional intensity (d = 0.74), as well as more focused challenge (d = 0.35) than laypeople. CBT trainees preferred more therapist directiveness (d = 2.00), less emotional intensity (d = 0.51), more present orientation (d = 0.76) and more focused challenge (d = 0.33) than trainees in psychodynamic/psychoanalytic therapy. Conclusion: Overall, the results underline the importance of implementing preference assessment and discussion during psychotherapy training. Moreover, therapists of different orientations seem to cover a large range of preferences for patients, in order to choose the right fit.

The Appalachia Mind Health Initiative (AMHI): a pragmatic randomized clinical trial of adjunctive internet-based cognitive behavior therapy for treating major depressive disorder among primary care patients

BackgroundMajor depressive disorder (MDD) is a leading cause of disease morbidity. Combined treatment with antidepressant medication (ADM) plus psychotherapy yields a much higher MDD remission rate than ADM only. But 77% of US MDD patients are nonetheless treated with ADM only despite strong patient preferences for psychotherapy. This mismatch is due at least in part to a combination of cost considerations and limited availability of psychotherapists, although stigma and reluctance of PCPs to refer patients for psychotherapy are also involved. Internet-based cognitive behaviorial therapy (i-CBT) addresses all of these problems.MethodsEnrolled patients (n = 3360) will be those who are beginning ADM-only treatment of MDD in primary care facilities throughout West Virginia, one of the poorest and most rural states in the country. Participating treatment providers and study staff at West Virginia University School of Medicine (WVU) will recruit patients and, after obtaining informed consent, administer a baseline self-report questionnaire (SRQ) and then randomize patients to 1 of 3 treatment arms with equal allocation: ADM only, ADM + self-guided i-CBT, and ADM + guided i-CBT. Follow-up SRQs will be administered 2, 4, 8, 13, 16, 26, 39, and 52 weeks after randomization. The trial has two primary objectives: to evaluate aggregate comparative treatment effects across the 3 arms and to estimate heterogeneity of treatment effects (HTE). The primary outcome will be episode remission based on a modified version of the patient-centered Remission from Depression Questionnaire (RDQ). The sample was powered to detect predictors of HTE that would increase the proportional remission rate by 20% by optimally assigning individuals as opposed to randomly assigning them into three treatment groups of equal size.Aggregate comparative treatment effects will be estimated using intent-to-treat analysis methods. Cumulative inverse probability weights will be used to deal with loss to follow-up. A wide range of self-report predictors of MDD heterogeneity of treatment effects based on previous studies will be included in the baseline SRQ. A state-of-the-art ensemble machine learning method will be used to estimate HTE.DiscussionThe study is innovative in using a rich baseline assessment and in having a sample large enough to carry out a well-powered analysis of heterogeneity of treatment effects. We anticipate finding that self-guided and guided i-CBT will both improve outcomes compared to ADM only. We also anticipate finding that the comparative advantages of adding i-CBT to ADM will vary significantly across patients. We hope to develop a stable individualized treatment rule that will allow patients and treatment providers to improve aggregate treatment outcomes by deciding collaboratively when ADM treatment should be augmented with i-CBT.Trial registrationClinicalTrials.gov NCT04120285. Registered on October 19, 2019.

Older Veterans’ Treatment Preferences: Psychotherapy and Self-Management Treatment Modalities

ABSTRACT Objectives Self-management may help older Veterans with mental health challenges and can overcome barriers to traditional psychotherapy. However, the reasons underlying older Veterans’ treatment preferences remain unknown. The current study investigated older Veterans’ perspectives on psychotherapy and self-management. Methods Seventy-four Veterans ≥ 60 years old were included in this mixed methods study. Participants provided rationale(s) after ranking their preferences for psychotherapy and four self-management modalities. Logistic regressions examined whether depressive and anxiety symptom severity contributes to preferences. Qualitative analyses were conducted to investigate reasoning for preferences. Results Most participants preferred psychotherapy (64.9%) over self-management (35.1%). Logistic regressions showed that depressive and anxiety symptom severity was not significantly associated with preferences. Qualitative analyses revealed that past experience and access-related barriers were underlying the preferences. Themes unique to psychotherapy included the availability of emotional support and the process of information sharing. In contrast, ease of access was associated with self-management. Conclusions Older Veterans preferred psychotherapy to receive support and to develop trust in meeting their goals. Clinical Implications Older Veterans’ needs point to the importance of providers’ consideration of a person-centered approach and treatment collaboration. Notably, Veterans’ preference for psychotherapy highlights the importance and need for human support in addition to self-management tools.

Are Veterans Getting Their Preferred Depression Treatment? A National Observational Study in the Veterans Health Administration

BackgroundPhysician responsiveness to patient preferences for depression treatment may improve treatment adherence and clinical outcomes.ObjectiveTo examine associations of patient treatment preferences with types of depression treatment received and treatment adherence among Veterans initiating depression treatment.DesignPatient self-report surveys at treatment initiation linked to medical records.SettingVeterans Health Administration (VA) clinics nationally, 2018–2020.ParticipantsA total of 2582 patients (76.7% male, mean age 48.7 years, 62.3% Non-Hispanic White)Main MeasuresPatient self-reported preferences for medication and psychotherapy on 0–10 self-anchoring visual analog scales (0=“completely unwilling”; 10=“completely willing”). Treatment receipt and adherence (refilling medications; attending 3+ psychotherapy sessions) over 3 months. Logistic regression models controlled for socio-demographics and geographic variables.Key ResultsMore patients reported strong preferences (10/10) for psychotherapy than medication (51.2% versus 36.7%, McNemar χ21=175.3, p<0.001). A total of 32.1% of patients who preferred (7–10/10) medication and 21.8% who preferred psychotherapy did not receive these treatments. Patients who strongly preferred medication were substantially more likely to receive medication than those who had strong negative preferences (odds ratios [OR]=17.5; 95% confidence interval [CI]=12.5–24.5). Compared with patients who had strong negative psychotherapy preferences, those with strong psychotherapy preferences were about twice as likely to receive psychotherapy (OR=1.9; 95% CI=1.0–3.5). Patients who strongly preferred psychotherapy were more likely to adhere to psychotherapy than those with strong negative preferences (OR=3.3; 95% CI=1.4–7.4). Treatment preferences were not associated with medication or combined treatment adherence. Patients in primary care settings had lower odds of receiving (but not adhering to) psychotherapy than patients in specialty mental health settings. Depression severity was not associated with treatment receipt or adherence.ConclusionsMismatches between treatment preferences and treatment type received were common and associated with worse treatment adherence for psychotherapy. Future research could examine ways to decrease mismatch between patient preferences and treatments received and potential effects on patient outcomes.

Psychoterapia: metoda leczenia prowadzona przez kobiety i dla kobiet? O zjawisku feminizacji w psychoterapii.

There has occurred a significant change in psychotherapy for recent decades. Previously psychotherapy was mostly defined and conducted by men, nowadays in Poland, nearly 80% of psychotherapists are women. It can be seen as an indication of the ongoing feminization process. The authors are considering a possible impact of this change on the image of psychotherapy as well as on the way it is conducted. The „good patient” profile is analyzed to answer the question of whether it is becoming to be a women’s profile. Several reasons for this to occur are discussed — differences within the socialization process, defense mechanisms, and preferences for psychotherapy between men and women. In conclusion, a few clues for psychotherapists to consider were recommended.

Challenging assumptions about what men want: Examining preferences for psychotherapy among men attending outpatient mental health clinics.

Understanding men's preferences for outpatient mental health treatment is important in better providing responsive services that engage this population in effectual care. In psychotherapy, responding to client preferences is associated with reduced attrition and improved outcomes. Knowledge regarding men's therapy preferences, however, is limited and equivocal, particularly among men attending outpatient mental health services. The present study examined treatment preferences-with a focus on psychotherapy- in a sample of Canadian men (N = 92) attending public-funded outpatient clinics. The majority of men (45.7%) endorsed a strong preference for individual psychotherapy. This preference was associated with higher levels of work and social impairment. Men tended to prefer therapists to teach coping strategies, explore feelings and patterns of experiences, and assist men in working with emotions. Only 20.9% of men preferred brief treatment, and 31.4% perceived a need for long-term therapy (>1 year). Contrary to popular discourse, findings indicated respondents' preference for therapies that focus on vulnerable emotions, and many men-particularly those with greater functional impairment-reported interest in longer term, emotion-oriented psychotherapy.

Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder.

Importance: In the treatment of persistent depressive disorder (PDD), disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been shown to be superior to Supportive Psychotherapy (SP) in outpatients. It remains to clear which subgroups of patients benefit equally and differentially from both psychotherapies.Objective: To identify those patient-level baseline characteristics that predict a comparable treatment effectiveness of CBASP and SP and those that moderate the differential effectiveness of CBASP compared to SP.Design, setting and participants: In this analysis of a 48-week multicenter randomized clinical trial comparing CBASP to SP in adult antidepressant-free outpatients with early-onset PDD, we evaluated baseline variables from the following domains as potential predictors and moderators of treatment effectiveness: socio-demography, clinical status, psychosocial and global functioning, life quality, interpersonal problems, childhood trauma, treatment history, preference for psychotherapy, and treatment expectancy.Interventions: A 48-week treatment program with 32 sessions of either CBASP or SP.Main outcomes and measures: Depression severity measured by the 24-item Hamilton Rating Scale for Depression (HRSD-24) at week 48.Results: From N = 268 randomized outpatients, N = 209 completed the 48-week treatment program. CBASP completers had significantly lower post-treatment HRSD-24 scores than SP completers (meanCBASP=13.96, sdCBASP= 9.56; meanSP= 16.69, sdSP= 9.87; p = 0.04). A poor response to both therapies was predicted by higher baseline levels of clinician-rated depression, elevated suicidality, comorbid anxiety, lower social functioning, higher social inhibition, moderate-to-severe early emotional or sexual abuse, no preference for psychotherapy, and the history of at least one previous inpatient treatment. Moderator analyses revealed that patients with higher baseline levels of self-rated depression, comorbidity of at least one Axis-I disorder, self-reported moderate-to-severe early emotional or physical neglect, or at least one previous antidepressant treatment, had a significantly lower post-treatment depression severity with CBASP compared to SP (all p < 0.05).Conclusions and relevance: A complex multifactorial interaction between severe symptoms of depression, suicidality, and traumatic childhood experiences characterized by abuse, social inhibition, and anxiety may represent the basis of non-response to psychotherapy in patients with early onset PDD. Specific psychotherapy with CBASP might, however, be more effective and recommendable for a variety of particularly burdened patients compared to SP.

Expectations and Preferences for Psychotherapy Among African American and White Young Adults.

This study examined beliefs, expectations, and preferences related to mental health problems and treatment in a sample of young adults who are in a developmental period when many types of psychopathology emerge. Prior studies on this topic have primarily included samples that are older and predominately White. It is not clear whether results from that research generalize to diverse samples of young adults. Participants were 370 undergraduate students (41.3% African American; 76.5% female) who completed questionnaires about expectations and preferences for psychotherapy and therapists. Findings regarding racial differences include African Americans having less experience with mental health services and different goals for psychotherapy than did Whites. Additionally, African Americans, relative to Whites, demonstrated stronger preferences for couple, family, and group psychotherapy, a male therapist their same race, and a therapist who is assertive and structured in session. The results of this study provide information about young adults' perceptions, expectations, and preferences related to mental health problems and psychotherapy. Findings suggest some barriers to treatment that might be addressed to improve treatment engagement and utilization of psychological services among young adults in general and among African American young adults specifically.

Personality Assessment and Psychotherapy Preferences: Congruence between Client Personality and Therapist Personality Preferences

Consideration of client preferences has been emphasized as important to therapeutic outcomes, such as treatment engagement and retention. Although studies have investigated several client and therapist characteristics associated with client preferences, few have considered whether people have preferences regarding a potential therapist’s personality. The current study extended prior research on client preferences by examining the influence of participants’ Big Five personality traits on preferences for therapist personality characteristics utilizing latent profile analysis. We expected congruence between client personality traits and preferred psychotherapist personality traits. In both undergraduate and community samples, results indicated that participants generally prefer a psychotherapist with personality characteristics similar to their own. Our findings establish the presence of preferences based on personality factors and have implications for future research directions and the role of personality assessment in routine clinical practice.

The Cost-Effectiveness of Cognitive Behavioral Therapy Versus Second-Generation Antidepressants for Initial Treatment of Major Depressive Disorder in the United States: A Decision Analytic Model.

Most guidelines for major depressive disorder recommend initial treatment with either a second-generation antidepressant (SGA) or cognitive behavioral therapy (CBT). Although most trials suggest that these treatments have similar efficacy, their health economic implications are uncertain. To quantify the cost-effectiveness of CBT versus SGA for initial treatment of depression. Decision analytic model. Relative effectiveness data from a meta-analysis of randomized controlled trials; additional clinical and economic data from other publications. Adults with newly diagnosed major depressive disorder in the United States. 1 to 5 years. Health care sector and societal. Initial treatment with either an SGA or group and individual CBT. Costs in 2014 U.S. dollars, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. In model projections, CBT produced higher QALYs (3 days more at 1 year and 20 days more at 5 years) with higher costs at 1 year (health care sector, $900; societal, $1500) but lower costs at 5 years (health care sector, -$1800; societal, -$2500). In probabilistic sensitivity analyses, SGA had a 64% to 77% likelihood of having an incremental cost-effectiveness ratio of $100000 or less per QALY at 1 year; CBT had a 73% to 77% likelihood at 5 years. Uncertainty in the relative risk for relapse of depression contributed the most to overall uncertainty in the optimal treatment. Long-term trials comparing CBT and SGA are lacking. Neither SGAs nor CBT provides consistently superior cost-effectiveness relative to the other. Given many patients' preference for psychotherapy over pharmacotherapy, increasing patient access to CBT may be warranted. Department of Veterans Affairs, National Institute of Mental Health.

Embedded Maternal Mental Health Care in a Pediatric Primary Care Clinic: A Qualitative Exploration of Mothers’ Experiences

ObjectiveThe American Academy of Pediatrics recommends screening parents for postpartum depression during pediatric primary care visits. Unfortunately, many women who screen positive do not obtain treatment. Providing mental health services for women in the same location as their children's primary care may facilitate treatment, but few such clinics exist. We designed a qualitative study to evaluate women's perceptions and experiences with receiving mental health services from psychiatrists embedded in a safety-net pediatric primary care clinic. MethodsSemistructured interviews were conducted with women receiving mental health care from embedded psychiatrists in a safety-net pediatric clinic. Data were analyzed using an inductive approach. ResultsTwenty women participated. Five major themes emerged: 1) barriers to maternal mental health care, including psychiatric symptoms impairing access, stigma, and fear of Child Protective Services; 2) benefits of embedded care, including convenience, low barrier to entry and trust; 3) motherhood as facilitator to care, with early motherhood described as a time of vulnerability to relapse; 4) focus on parenting, including appreciation for parenting skills and normalization of the mothering experience; 5) treatment modality preferences, including concerns about medications and a preference for psychotherapy. ConclusionsPostpartum women face many barriers to psychiatric care. Mental health care embedded within the pediatric setting lowers barriers to care during this critical period. These insights should inform further collaboration between adult psychiatrists and pediatric care providers.

Causal explanations of depression and treatment credibility in adults with untreated depression: Examining attribution theory.

Understanding depression as biologically caused has been shown to impact both treatment preferences and prognostic pessimism. Attribution theory has been posited as an explanation for this relationship. Given that evidence-based psychotherapy is effective yet often not delivered to individuals with depression, the present study sought to determine factors that impact treatment credibility. Non-treatment-seeking, depressed individuals (n=229) were randomly assigned to read a psychoeducation article about depression that consisted of a biological causal explanation, psychosocial causal explanation, or a non-causal control. Attributional dimensions of locus, stability, and control were examined as mediating the relationship between causal explanation and treatment credibility and prognostic pessimism. Individuals in the biological condition were more likely to find antidepressant medication a credible treatment for depression. The manipulation had no direct effect on preference for psychotherapy orprognostic pessimism. Attributional dimensions of locus, stability, and control did not mediate the relationship between causal explanation and treatment credibility. To the extent that the psychosocial article increased perceived instability of the depression cause, however, prognostic pessimism was reduced. The present study has implications for framing education about depression in mental health literacy programs and public awareness campaigns. This study found that conceptualizing depression as biologically caused increased the credibility of medication but not psychotherapy Participants reading a biological explanation of depression demonstrated an increase on some aspects of stigma and prognostic pessimism Emphasizing the person-environment interaction rather than biological causes decreased the perceived stability of depression which was associated with a decrease in prognostic pessimism.

Psychotherapy preferences of laypersons and mental health professionals: Whose therapy is it?

What do patients prefer in their psychotherapy? Do laypersons and mental health professionals (as patients) want the same, or different, things? The authors systematically examined patients' psychotherapy preferences and quantitatively compared two samples of laypersons (N = 228, 1,305) with one sample of mental health professionals (N = 615) on the four dimensions of the Cooper-Norcross Inventory of Preferences: Therapist Directiveness Versus Client Directiveness, Emotional Intensity Versus Emotional Reserve, Past Orientation Versus Present Orientation, and Warm Support Versus Focused Challenge. On average, laypersons wanted therapist directiveness and emotional intensity. Robust differences were found between laypersons' and professionals' preferences on these two dimensions: Mental health professionals wanted less therapist directiveness than did laypersons (gs = 0.92 and 1.43 between groups) and more emotional intensity (gs = 0.49 and 1.33). Women also wanted more warm support than men (gs = 0.40 and 0.57). These findings suggest that psychotherapists should be mindful of their own treatment preferences and ensure that these are not inappropriately generalized to patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predictors of men's psychotherapy preferences

AbstractAimThe current study examined men's perceptions and preferences for four types of psychotherapy.MethodMen (N = 315) were recruited by Qualtrics panels to complete a survey that included vignettes describing therapeutic orientations.ResultsHierarchical regression analyses demonstrated that gender role socialisation, self‐stigma and attitudes about professional psychological help negatively predicted willingness to engage in psychodynamic, person‐centred, cognitive behavioural and positive psychology positive masculinity therapy. Furthermore, men in the study preferred positive psychology positive masculinity therapy to cognitive behavioural therapy.ConclusionGiven the role of gender role socialisation, self‐stigma and fear of femininity in the development of barriers to men's help‐seeking, the present study provides support for “man friendly” therapeutic orientations such as the positive psychology positive masculinity model. Implications for clinical practice and future directions for research are discussed.

Effectiveness of psychotherapy for treatment-resistant depression: a meta-analysis and meta-regression.

Despite substantial advances in treatment and management strategies for major depression, less than 50% of patients respond to first-line antidepressant treatment or psychotherapy. Given the growing number of controlled studies of psychotherapy for treatment-resistant depression (TRD) and the preference for psychotherapy of depressed subjects as a treatment option, we conducted a meta-analysis and meta-regression analysis to investigate the effectiveness of psychotherapy for TRD. Seven different psychotherapies were studied in 21 trials that included a total of 25 comparisons. In three comparisons of psychotherapy v. treatment as usual (TAU) we found no evidence to conclude that there is a significant benefit of psychotherapy as compared with TAU. In 22 comparisons of add-on psychotherapy plus TAU v. TAU only, we found a moderate general effect size of 0.42 (95% CI 0.29-0.54) in favor of psychotherapy plus TAU. The meta-regression provided evidence for a positive association between baseline severity as well as group v. individual therapy format with the treatment effect. There was no evidence for publication bias. Most frequent investigated treatments were cognitive behavior therapy, interpersonal psychotherapy, mindfulness-based cognitive therapy, and cognitive behavioral analysis system of psychotherapy. Our meta-analysis provides evidence that, in addition to pharmacological and neurostimulatory treatments, the inclusion of add-on of psychotherapy to TAU in guidelines for the treatment of TRD is justified and will provide better outcomes for this difficult-to-treat population.

Preferences for Depression Treatment Including Internet-Based Interventions: Results From a Large Sample of Primary Care Patients.

Background: To date, little is known about treatment preferences for depression concerning new media. This study aims to (1) investigate treatment preferences for depression including internet-based interventions and (2) examine subgroup differences concerning age, gender and severity of depression as well as patient-related factors associated with treatment preferences.Methods: Data were derived from the baseline assessment of the @ktiv-trial. Depression treatment preferences were assessed from n = 641 primary care patients with mild to moderate depression regarding the following treatments: medication, psychotherapy, combined treatment, alternative treatment, talking to friends and family, exercise, self-help literature, and internet-based interventions. Depression severity was specified by GPs according to ICD-10 criteria. Ordinal logistic regression models were conducted to identify associated factors of treatment preferences.Results: Patients had a mean age of 43.9 years (SD = 13.8) and more than two thirds (68.6%) were female. About 43% of patients had mild depression while 57% were diagnosed with moderate depression. The majority of patients reported strong preferences for psychotherapy, talking to friends and family, and exercise. About one in five patients was very likely to consider internet-based interventions in case of depression. Younger patients expressed significantly stronger treatment preferences for psychotherapy and internet-based interventions than older patients. The most salient factors associated with treatment preferences were the patients' education and perceived self-efficacy.Conclusions: Patients with depression report individually different treatment preferences.Our results underline the importance of shared decision-making within primary care. Future studies should investigate treatment preferences for different types of internet-based interventions.