Psychotherapy Outcome Literature Research Articles

Understanding how online solution–focused hypnotherapy can support the wellbeing of police personnel and treat symptoms of anxiety and depression

Background: The mental health and wellbeing of police personnel has received increased attention over the last 5 years and rates of mental illness amongst employees are high. Anxiety and depression are the most common mental illnesses within the police force, yet little is known about how effective psychotherapeutic interventions are in treating the symptoms of these mental illnesses in police personnel, that is, how many police personnel recover from anxiety and depression after completing a course of psychotherapy. In the psychotherapy outcome literature, recovery rates for anxiety and depression in clinical samples following treatment are low, between 37% and 47%, suggesting similar outcomes can be expected within the police force using current therapy models. Further research into new or unused interventions is therefore needed to improve recovery rates within the police force. Method: This pilot study explored how a new type of psychotherapy, online Solution Focused Hypnotherapy (SFH), can support the wellbeing of police personnel and effectively treat symptoms of anxiety and depression. A quantitative design was used to measure changes in anxiety (GAD-7) and depression (PHQ-9) symptom severity at pre- and post-intervention and measure changes in wellness using a rating scale (Life Wellness Indicator Tool) at the end of each session. Results: A total of 42 police personnel, both officers and staff, participated in the study and 20 qualified SFH therapists delivered the online intervention. The main finding was that 78% of police personnel who completed a course of SFH and started with clinically significant symptoms of anxiety and/or depression had recovered from their illness following the intervention (i.e. scored below 5 on at least one outcome measure). A total of 97.2% of participants achieved ‘wellness’ after the intervention, compared to 19% at pre-intervention and no participants experienced an increase in symptom scores after completing the intervention. Conclusion: Online Solution Focused Hypnotherapy (SFH) can support the wellbeing of both police officers and staff and effectively treat the symptoms of anxiety and depression. Our findings suggest that SFH is an effective, well liked and safe intervention to use within the police force and provides support for more resources into a larger randomised controlled trial.

An update on the Pharmacological and Psychotherapeutic Management of Treatment Resistant OCD

AbstractAlthough the rates of response to first-line pharmacological treatments (serotonin reuptake inhibitors – SRIs) are generally twice that of placebo, only 40-60% of patients respond sufficiently or are able to tolerate traditional first-line pharmacotherapy. Augmentation with dopamine antagonist medications is associated with the strongest evidence, yet dopamine antagonists benefit only a minority of those who try them and carry elevated risks of adverse effects. Based on evolving pathophysiologic models of OCD, a variety of agents targeting serotonin, dopamine, norepinephrine, glutamate, and anti-inflammatory pathways have been explored as alternative or adjunctive therapies for treatment-resistant OCD and have at least preliminary evidence of efficacy. Similarly, approximately 50% of patients do not respond optimally to first psychotherapeutic treatments including cognitive behavioural therapy (CBT) and exposure and response prevention (ERP), even when combined with pharmacotherapy. The psychotherapy outcome literature is heterogeneous and very few psychological strategies have been developed specifically to treat treatment resistant OCD. However, a recent systematic review concluded that CBT improved treatment response in individuals with pharmacotherapy resistance. This presentation will present an update on the pharmacological and psychotherapeutic treatment of refractory OCD including novel strategies such as the use of psychedelics.Disclosure of InterestM. Van Ameringen Grant / Research support from: Elvium, CIHR,Hamilton Academic Health Sciences Organization, Consultant of: Abbvie, Bausch Health, Boehringer Ingelheim, Elvium, Jazz, Vistagen, Speakers bureau of: Abbvie, Elvium (Purdue), Lundbeck, Otsuka, Sunovion, and Takeda

Evidence base for psychological treatment of personality disorder – a narrative review

AimsThis review critically appraises the up-to-date evidence base for psychological treatment of PD.BackgroundThe prevalence rate of any personality disorder (PD) in the general population has been estimated to be as high as 12% rising to over 70% in prison settings. PD is known to carry significant psychosocial and health burdens with increased mortality, increased suicide, increased substance misuse, increased crime, reduced capacity to work, poorer outcomes for comorbid mental disorders, dysfunctional engagement with services, and high economic costs through a high utilisation of healthcare systems. In the 1990s several manualised treatment strategies emerged, specifically for borderline PD. These include dialectical behaviour therapy, cognitive therapy, cognitive analytic therapy, mentalization-based therapy, transference-focused psychotherapy, and schema-focussed therapy.MethodUsing relevant search criteria, literature was identified through a search of the following databases: PubMed, EMBASE, and PsycINFO. Data were appraised and synthesised to provide a comprehensive overview of the current evidence base for psychological treatment of PD.ResultThe DSM-V defined Cluster B borderline PD has received the majority of attention. Increasing attention has been paid in recent years to the Cluster B antisocial PD. Cluster A (Paranoid, Schizoid, Schizotypal) and Cluster C PDs (Avoidant, Dependent, Obsessive Compulsive) have received relatively little attention with few studies to draw upon regarding the effectiveness of therapy. The remaining Cluster B personality disorders (Narcissistic and Histrionic) have been criticised as having poor construct validity, with a lack of rigorously designed treatment trials.A number of treatment protocols have gained empirical support. However, of those that have empirical support, there appears to be little demonstrable evidence to suggest superiority of any one of the evidence-based interventions over another. While specialised therapies are more efficacious than “treatment as usual” or treatment delivered by expert clinicians, when specialised therapies are compared with well-specified manualised general psychiatric care tailored to personality disorder, the results are different, with little consistent evidence demonstrating the superiority of specialised therapies.ConclusionCurrent evidence suggests that individual therapies do not differ substantially from each other or from structured clinical care that relies on generic change factors. This is in keeping with established psychotherapy outcome literature. Current evidence would indicate that common features across the proven treatment strategies should be emphasised and implemented well. There may be justification for added interventions from specific treatment modalities targeted to specific patient problems.

The Persistent Case of Major Depression: An Argument for Long-Term Treatment

According to psychotherapy outcome literature, treatments for major depressive disorder (MDD) yield impressive results. Study after study demonstrates the efficacy of brief, evidence-based interventions for depressed individuals. Nevertheless, MDD continues to exact a devastating toll on modern society. The World Health Organization has identified it as the leading cause of disability worldwide. This reality is surprising given the implications from the academic literature. A historical analysis of MDD treatment suggests that most people with MDD experienced complete remission and enhanced outcomes when long-term, psychodynamically influenced treatments prevailed. An analysis of the system that perpetuates the brief intervention model for MDD, managed care, is discussed. This analysis is followed by a case study that illustrates the harm managed care can do to patients with MDD who are not permitted treatment of longer duration. Implications and recommendations for psychologists to intervene at the micro and macro levels are discussed.

A review of psychotherapy outcome research: Considerations for school‐based mental health providers

AbstractEvaluating psychotherapeutic outcome is an important endeavor given psychology's focus on identifying effective treatments. There is ample evidence to suggest that psychotherapy interventions for children and adolescents are effective. Unfortunately, the child and adolescent psychotherapy outcome literature lags behind the adult‐focused outcome literature in some important areas, as children and adolescents are often viewed as extensions of adults. This review analyzes the pertinent youth meta‐analyses, examining treatment, client, and therapist variables relevant to positive outcomes. We also consider the impact of variables that have received more attention in the adult psychotherapy outcome literature (i.e., the therapeutic alliance, therapist effects, and allegiance effects) and their possible impact on child and adolescent outcomes. Our hope is that this discussion benefits school‐based mental health professionals when discerning what works best with the youth population. © 2010 Wiley Periodicals, Inc.

Effectiveness of school‐based psychotherapy: A meta‐analysis of dissertation research

AbstractA meta‐analysis was conducted with 65 school‐based psychotherapy and counseling dissertations over the last 10 years (1998–2008) to assess if a file‐drawer problem (i.e., studies conducted but not published that, as a whole, have different results than studies in the same area published) exists in the school‐based outcome literature. An overall mean effect size of 0.44 was found for 73 treatment interventions. This effect size is comparable to Prout and DeMartino's 1986 meta‐analysis conducted with published school‐based studies and approximately half a standard deviation smaller than Prout and Prout's 1998 meta‐analysis of school‐based intervention studies. A bias does appear to exist but seems to be smaller than the bias found in the general child and adolescent psychotherapy outcome literature. Most of the dissertation studies evaluated group interventions and used a cognitive–behavioral or skills training intervention. Skills training and interventions with elementary‐school students yielded the largest effect sizes. Comparisons of the current study with previous school‐based intervention meta‐analyses are discussed as are suggestions for future research. © 2010 Wiley Periodicals, Inc.

Psychotherapy Update for the Practicing Psychiatrist: Promoting Evidence-Based Practice

The last three decades have witnessed significant advances in psychotherapy. Numerous scholarly articles and books have been devoted to pertinent topics in the field, making it difficult for the practicing clinician to keep up with this rapidly growing area. The purpose of this article is to provide some guidelines on how to evaluate the empirical literature in psychotherapy and then to explore three key areas: evidence-based psychotherapies for patients with psychiatric disorders, individual variables that predict differential outcome to treatment, and the therapeutic alliance. Finally, two case examples will be presented to illustrate how knowledge of the empirical literature can facilitate an evidence-based approach to the daily practice of psychotherapy in general psychiatry.

Telephone-Delivered, Interpersonal Psychotherapy for HIV-Infected Rural Persons With Depression: A Pilot Trial

Telephone-Delivered, Interpersonal Psychotherapy for HIV-Infected Rural Persons With Depression: A Pilot Trial

Assessment implications of “What Works” research for Dangerous and Severe Personality Disorder (DSPD) service evaluation

A policy initiative intended to address the risk posed by individuals considered dangerous and severely personality disordered has seen the introduction of specialized services for high-risk offenders in secure settings within both the mental health and prison systems in the UK. Accompanying these developments has been an explicit research agenda which includes among its priorities treatment evaluation research with these newly identified dangerous and severe personality disorder (DSPD) offenders. This article discusses a number of key concepts identified from the psychotherapy outcome literature and relates their significance for evaluation research designs to principles drawn from the “What Works” criminological literature with the aim of informing research initiatives within the DSPD service.

Are samples in randomized controlled trials of psychotherapy representative of community outpatients? A new methodology and initial findings.

To determine the extent to which published randomized controlled trials (RCTs) of psychotherapy can be generalized to a sample of community outpatients, the authors used a method of matching information obtained from outpatient charts to inclusion and exclusion criteria from published RCT studies. They found that 80% of the patients in their sample who had diagnoses represented in the RCT literature were judged eligible for at least 1 published RCT; however, 58% of the patients had primary diagnoses such as adjustment disorder or dysthymia, which were not represented in the existing psychotherapy outcome literature. The most common reasons that patients in their sample did not match with published RCTs for psychotherapy are listed, and the implications of these findings for research and practice are discussed.

CHANGING STAFF ATTITUDES AND EMPATHY FOR WORKING WITH PEOPLE WITH PSYCHOSIS

Seventy-seven mental health professionals completed a 3-day cognitive behavioural training course for managing hallucinations and delusions in schizophrenia. A questionnaire measuring attitudes and empathy towards working with people who have these symptoms was administered before and after the course. Significant increases in feelings of adequacy, legitimacy, employment related self-esteem, and expectations of work satisfaction were observed after the course and participants displayed high levels of motivation for working with this clinical population at both time points. In addition, the participants showed significant increases in perceived empathy for the experience of hallucinations and delusions. This was a predicted outcome as the course included exercises designed to enhance therapists' understanding of the subjective experience of psychotic symptoms. Empathy is recognized in the wider psychotherapy outcome literature as a therapeutically important variable that influences the formation of a therapeutic alliance but it is a relatively unexamined construct in CBT for psychosis. Further investigations in this area will potentially enhance psychological treatment delivery and subsequent outcomes for people who experience hallucinations and delusions. Furthermore, explication of such “non-specific” therapeutic factors may help to explain some of the transient but beneficial effects of unstructured “control” therapies observed in recent CBT for psychosis outcome trials.

Does criminal offender treatment work?

In examining the effectiveness of offender treatment, this article attempts to integrate disparate bodies of knowledge. An overview of the effectiveness of offender treatment is presented. To put offender treatment into perspectives, the psychotherapy outcome literature for nonoffenders is briefly reviewed. The complexity of offender treatment is further explored by reviewing correlates and antecedents of criminality that include antisocial personality disorder, antisocial behavior in children, and substance abuse. Implications of the existing body of knowledge on future policy and more active involvement by psychologists are discussed.

A meta-analysis of outcome studies comparing bona fide psychotherapies: Empiricially, "all must have prizes."

This recta-analysis tested the Dodo bird conjecture, which states that when psychotherapies intended to be therapeutic are compared, the true differences among all such treatments are 0. Based on comparisons between treatments culled from 6 journals, it was found that the effect sizes were homogeneously distributed about 0, as was expected under the Dodo bird conjecture, and that under the most liberal assumptions, the upper bound of the true effect was about .20. Moreover, the effect sizes (a) were not related positively to publication date, indicating that improving research methods were not detecting effects, and (b) were not related to the similarity of the treatments, indicating that more dissimilar treatments did not produce larger effects, as would be expected if the Dodo bird conjecture was false. The evidence from these analyses supports the conjecture that the efficacy of bona fide treatments are roughly equivalent. In 1936, Rosenzweig proposed that common factors were responsible for the efficacy of psychotherapy and used the conclusion of the Dodo bird from Alice in Wonderland (Carroll, 1865/1962) to emphasize this point: At last the Dodo said, 'Everybody has won, and all must have prizes' (p. 412). Later, Luborsky, Singer, and Luborsky ( 1975 ) reviewed the psychotherapy outcome literature, found that the psychotherapies reviewed were generally equivalent in terms of their outcomes, and decreed that the Dodo bird was correct. Since Luborsky et al.'s seminal review, the equivalence of outcome in psychotherapy has been called the Dodo bird effect. To many interested in the technical aspects of particular psychotherapies, the Dodo bird effect was distasteful and, on the face of it, unbelievable: If the indiscriminate distribution of prizes argument carried true conviction . . . we end up with the same advice for everyoneRegardless of the nature of your problem seek any form of psychotherapy. This is absurd. We doubt whether even the strongest advocates of the Dodo bird argument dispense this advice. (Rachman & Wilson, 1980, p. 167)

THE PARADOX OF PSYCHODYNAMIC AND COGNITIVE-BEHAVIORAL PSYCHOTHERAPY

This paper briefly reviews the literature on psychodynamic therapy which suggests that its essential premises are severely flawed, and therefore should not yield therapeutic efficacy. In contrast, the principles of cognitive behavioral therapy (CBT) are supported by a vast body of experimental research and, consequently, should yield superior treatment outcomes. Despite this apparent logic, the psychotherapy outcome literature, which is also briefly reviewed, suggests psychodynamic and cognitive behavioral therapies produce roughly equivalent results. This paradox is resolved when the session transcripts of several psychodynamic practitioners are examined and these therapists in fact are practicing many key elements of CBT and rational-emotive behavioral therapy (REBT).

Communicative efficacy of psychotherapy research.

Practitioners have claimed that information relevant to psychotherapy application is not regularly provided in professional journals. A survey of the 1985-1987 psychotherapy outcome literature investigated the extent of specific points of information in journal reports. Results partially support the complaint that pertinent information is not routinely available. No content area addressed found consistent representation. Noticeable deficiencies were tabulated for specific categories of patient demographics, disorder description, and replication studies. This suggests an underacknowledgement of the practical utility, both clinical and empirical, of common points of fact.

Meta-analysis: On the road to synthesis of knowledge?

The future of meta-analysis is considered following an overview of its methodological procedures and the trends in their application to the psychotherapy outcome literature. Methodological issues, such as quality selection and the potential moderating effects of methods on outcomes, are addressed. Proposals for future meta-analysis reports are offered. The need for normative comparisons and the assessment and quantification of the quality of therapy are specifically recommended.