Psychotherapy Sessions Research Articles

The Value of Nature During Psychotherapy: A Qualitative Study of Client Experiences.

Nature is considered to have restorative qualities that can potentially improve psychotherapy success. However, little is known about how clients experience nature during psychotherapy. The research aim of this phenomenological qualitative study was to study how clients experience nature during individual outpatient psychotherapy that took place while walking in nature. More specifically we were interested in clients’ inner world experiences. All participants (N = 12) received treatment through licensed therapists for a DSM-5 classified disorder. Semi-structured interviews were conducted. To uncover true lived experiences during these interviews, participants were asked to close their eyes and envision themselves during a psychotherapy session in nature. The verbatim transcripts were coded by means of inductive thematic analysis and the results were member checked. Results showed that nature brings clients closer to their inner worlds. How nature brings this about is unfolded in a conceptual model of lived experience. We argue that psychotherapy can be enriched by considering nature as a supportive environment because bringing clients closer to their inner worlds is of essential value in facilitating successful treatment interventions.

Individual psychotherapy can reduce suicidal ideation in first episode psychosis: Further findings from the 2-year follow-up of the 'Parma Early Psychosis' programme.

Suicidal thinking is relevant in patients with First Episode Psychosis (FEP). However, longitudinal studies specifically examining treatment response for suicidal ideation in FEP are still relatively scarce, especially with long-term design and in real-world clinical settings. The aims of this research were (A) to longitudinally assess suicidal thoughts in people with FEP along a 2-year follow-up period and (B) to overtime investigate any significant association of suicidal ideation levels with the specific treatment components of an 'Early Intervention in Psychosis' (EIP) protocol along the 2years of follow-up. At entry, 232 FEP participants (aged 12-35 years) completed the Brief Psychiatric Rating Scale (BPRS), including a 'Suicidality' item subscore. Multiple linear regression analysis was then performed. Across the follow-up, FEP subjects showed a relevant decrease in suicidal thinking levels overtime. This was specifically predicted by the total number of individual psychotherapy sessions offered within the 2-year EIP protocol and antidepressant dose (at least as regards the first year of our intervention). Suicidal ideation is clinically relevant in FEP but seems to improve overtime together with the provision of specific, patient-tailored and integrated EIP treatments, especially individual psychotherapy.

Automated quality assessment of cognitive behavioral therapy sessions through highly contextualized language representations.

During a psychotherapy session, the counselor typically adopts techniques which are codified along specific dimensions (e.g., 'displays warmth and confidence', or 'attempts to set up collaboration') to facilitate the evaluation of the session. Those constructs, traditionally scored by trained human raters, reflect the complex nature of psychotherapy and highly depend on the context of the interaction. Recent advances in deep contextualized language models offer an avenue for accurate in-domain linguistic representations which can lead to robust recognition and scoring of such psychotherapy-relevant behavioral constructs, and support quality assurance and supervision. In this work, we propose a BERT-based model for automatic behavioral scoring of a specific type of psychotherapy, called Cognitive Behavioral Therapy (CBT), where prior work is limited to frequency-based language features and/or short text excerpts which do not capture the unique elements involved in a spontaneous long conversational interaction. The model focuses on the classification of therapy sessions with respect to the overall score achieved on the widely-used Cognitive Therapy Rating Scale (CTRS), but is trained in a multi-task manner in order to achieve higher interpretability. BERT-based representations are further augmented with available therapy metadata, providing relevant non-linguistic context and leading to consistent performance improvements. We train and evaluate our models on a set of 1,118 real-world therapy sessions, recorded and automatically transcribed. Our best model achieves an F1 score equal to 72.61% on the binary classification task of low vs. high total CTRS.

The Clinician-Administered Dissociative States Scale (CADSS): Validation of the German Version

ABSTRACT The Clinician-Administered Dissociative States Scale (CADSS) is a structured clinical interview to assess state dissociation rated by clinicians. The current study aimed to validate the German version of CADSS by comparing it to the established self-report measures for dissociation and exploring its underlying factor structure. Severity of within-session state dissociation was assessed directly following a standard psychotherapy session in a trauma-exposed patient sample (N= 105; 81.9% female). Internal consistency, convergent validity with other dissociation measures, and the factorial structure of the instrument were analyzed. The German version exhibited excellent internal consistency (Cronbach’s α = .94) and correlated significantly with self-report measures of state dissociation (r = .86) and trait dissociation (r = .77) indicative of high convergent validity. Exploratory factor analysis revealed a three-factor solution with the factors (1) Depersonalization/Derealization, (2) Identity Confusion/Alteration, and (3) Amnesia. Results support the CADSS as a useful instrument to assess state dissociation, conceptualized as a multidimensional construct, in clinical practice.

Psychotherapy as a Moderator of the Relationship Between Coping Strategies and Anxiety During the COVID-19 Pandemic.

The COVID-19 pandemic has led to the development of several risk factors for mental health, not only for people directly infected but also for those experiencing social isolation, loneliness, and concern for their health. The impact of these factors on individuals’ health and well-being also depends on the type of coping strategies adopted. Moreover, one of the main effects of COVID-19 is the increase in the prevalence of people who manifest anxious or depressive syndromes. This study investigates the relationship between coping strategies and a multidimensional assessment of anxiety symptoms measured during the COVID-19 pandemic in people who were having psychotherapy sessions, while participating in the study had psychotherapy sessions (clinical group) and those who have never done them (non-clinical group). The results of a questionnaire administered online to Italian subjects from June to July, 2020 were analyzed through multiple linear regressions methods to evaluate the role of psychotherapy as moderator between anxiety symptoms and coping strategies. The results of this study highlight that there are substantial differences in functioning between the clinical and non-clinical groups, underlying the key role of psychotherapy as a moderator between anxiety and the coping strategies of avoidance, social support, and positive attitude.

Pleasure, womanhood and the desire for reconstructive surgery after female genital cutting in Belgium

Growing numbers of women are showing interest in clitoral reconstructive surgery after ‘Female Genital Mutilation’. The safety and success of reconstructive surgery, however, has not clearly been established and due to lack of evidence the World Health Organization does not recommend it. Based on anthropological research among patients who requested surgery at the Brussels specialist clinic between 2017 and 2020, this paper looks at two cases of women who actually enjoy sex and experience pleasure but request the procedure to become ‘whole again’ after stigmatising experiences with health-care professionals, sexual partners or gossip among African migrant communities. An ethnographic approach was used including indepth interviews and participant observation during reception appointments, gynecological consultations, sexology and psychotherapy sessions. Despite limited evidence on the safety of the surgical intervention, surgery is often perceived as the ultimate remedy for the ‘missing’ clitoris. Such beliefs are nourished by predominant discourses of cut women as ‘sexually mutilated’. Following Butler, this article elicits how discursive practices on the physiological sex of a woman can shape her gender identity as a complete or incomplete person. We also examine what it was that changed the patients’ mind about the surgery in the process of re-building their confidence through sexology therapy and psychotherapy.

The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning With the Defense Mechanisms Rating Scales Q-Sort.

The psychodynamic concept of defense mechanisms is nowadays considered by professionals with various theoretical orientations of great importance in the understanding of human development and psychological functioning. More than half century of empirical research has demonstrated the impact of defensive functioning in psychological well-being, personality organization and treatment process-outcome. Despite the availability of a large number of measures for their evaluation, only a few instruments assess the whole hierarchy of defenses, based on the Defense Mechanisms Rating Scales (DMRS), which arguably offers an observer-rated gold standard of assessment. The present article illustrates the theoretical and methodological background of the DMRS-Q, the Q-sort version of the DMRS for clinical use. Starting from the definition and function of the 30 defense mechanisms included in the hierarchy, we extracted 150 items that captured a full range of defensive manifestations according to the DMRS theory. The DMRS-Q set is described in this paper with reference to the DMRS manual. Directions are also provided for using the DMRS-Q online software for the free and unlimited coding of defense mechanisms. After each coding, the DMRS-Q software provides a report including qualitative and quantitative scores reflecting the individual’s defensive functioning. Qualitative scores are displayed as the Defensive Profile Narratives (DPN), while quantitative scores are reported as Overall Defensive Functioning (ODF), defensive categories, defense levels, and individual defense mechanisms. Syntax for the scoring is displayed in the results and a clinical vignette of a psychotherapy session coded with the DMRS-Q is provided. The DMRS-Q is an easy-to-use, free, computerized measure that can help clinicians in monitoring changes in defense mechanisms, addressing therapeutic intervention, fostering symptoms decreasing and therapeutic alliance. Moreover, the DMRS-Q might be a valid tool for teaching the hierarchy of defense mechanisms and increase the observer-rated assessment of this construct in several research fields.

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.

Forming a Doctor-Patient Alliance During COVID-19 to Enhance Treatment Outcomes for Obsessive-Compulsive Disorder.

Forming a Doctor-Patient Alliance During COVID-19 to Enhance Treatment Outcomes for Obsessive-Compulsive Disorder.

Rosalind Dymond Cartwright (1922-2021).

Memorializes Rosalind Dymond Cartwright (1922-2021). She was a pioneer in the fields of empathy and psychotherapy research and one of the first women to make significant contributions to the science of sleep and dreams and the field of sleep medicine. Upon receiving her PhD in 1949, she took a position at Mount Holyoke College. After 2 years, she moved to the University of Chicago where Carl Rogers hired her to oversee the many studies of audiotaped psychotherapy sessions that he was conducting to test the effectiveness of client-centered therapy. In 1954, she and Rogers coedited the landmark book, Psychotherapy and Personality Change. She also held positions at the University of Illinois College of Medicine, University of Chicago, and Rush University Medical Center. From 1971 to 1993 she was a grant reviewer for the National Institute of Mental Health, a role that allowed her to advocate anonymously for the support of research and training programs that greatly influenced the course of sleep research in the United States. Beginning in 1990, Roz served pro bono as an expert witness for the defense in several murder cases that involved a defense of sleepwalking, a non-REM parasomnia. At age 90 she immersed herself in the technology of spectral analysis scoring of polysomnogram data to argue that recent laboratory-based discoveries about sleepwalkers could be used to determine whether an alleged crime might have been committed during an arousal from sleep in which consciousness was impaired. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The role of somatosensory stimulation in social phobia—An analysis of hand coordination in patients and therapeutic dyads during psychodynamic psychotherapy

AbstractIn the psychotherapeutic treatment of social phobia, the hand movement behaviour exhibited during the interaction provides information about the success of the therapy. In particular, the degree of mutual somatosensory stimulation of the hands (hands moving on each other, as a unit, apart) appears to be relevant regarding the patient's mental state. To test this hypothesis, the present study investigates hand coordination in the course of psychotherapy in patients with and without symptom improvement and in the corresponding therapeutic dyads. Forty‐two videos of patient–therapist dyads consisting of 21 patients (n = 11 non‐improved; n = 10 improved; according to Liebowitz Social Anxiety Scale self‐assessment) from the Social Phobia Research Network project were investigated in early psychotherapy sessions and in pre‐last sessions. Hand movements of four randomised video sequences per dyad were analysed with NEUROGES®‐ELAN. Patients with non‐improved symptoms displayed shorter act apart coordination and more act on each other coordination than patients with improved symptoms. Patients displayed more act apart and act on each other and less act as a unit coordination than therapists. In therapeutic dyads, act on each other coordination in early sessions, as well as short act apart coordination, was significantly related to non‐improvement. Patients with non‐improved symptoms are characterised by more hand coordination associated with a high degree of somatosensory stimulation serving self‐regulation (act on each other), as well as short complex gestural expressions (act apart). Thus, hand coordination constitutes a progression and outcome parameter informing on somatosensory stimulation.

The Relationship Between Defense Mechanisms and Attachment as Measured by Observer-Rated Methods in a Sample of Depressed Patients: A Pilot Study.

Despite many theoretical and clinical writings, the theorized connection between defense mechanisms and adult attachment in depressed patients has received little empirical attention. This is the first study to examine patients’ defense mechanisms in relation to their attachment in a clinical sample of depressed patients and also the first to use observer-rated measures for assessing both defense mechanisms and attachment. In this pilot study, we aimed to investigate the relationship between patients’ attachment and their use of defense mechanisms in psychotherapy sessions, as well as patterns of change over treatment. We conducted a secondary analysis of data from a randomized controlled trial of 30 patients receiving psychotherapy for major depression. Session transcripts were previously coded for defense mechanisms using the Defense Mechanisms Rating Scales, and depression severity data were collected by the clinician-rated HRSD-17 and the self-report BDI-II. Patients’ attachment was assessed in two transcripts, one in an early session and a second in a late session, using the novel observer-rated Patient Attachment Coding System. In contrast with expectations, in the early phase of therapy, preoccupied attachment-related characteristics were significantly positively related to overall defensive functioning and negatively related to Depressive immature defenses. In the late phase of treatment, preoccupied attachment-related characteristics were negatively correlated with Non-depressive immature defenses. Moreover, as expected, early-phase defense use was related to late phase attachment; specifically, early neurotic and immature Depressive and Non-depressive defenses predicted an increase in avoidant, whereas immature Non-depressive defenses predicted a decrease in preoccupied attachment-related characteristics over the course of treatment, after controlling for early attachment effects. The results imply a longitudinal relationship between defenses and change in attachment-related characteristics over the course of treatment in a depressed sample and warrant further research about the relationship between defenses and attachment during psychotherapy.

Effectiveness of Short-Term Psychodynamic Psychotherapy in Preadolescents and Adolescents Affected by Psychiatric Disorders.

ObjectiveFew studies have explored the effectiveness of short-term psychodynamic psychotherapy in children and adolescents. We aimed to investigate its efficacy in a heterogeneous group of young patients. We also wanted to check any relation between the improvement and patients’ age, sex, or diagnostic category. MethodsWe recruited a group of 123 patients (11 to 19 years old) with a diagnosis of psychiatric disorders confirmed by Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS). All participants received eight sessions of psychodynamic psychotherapy (“Brief Individuation Psychotherapy” by Senise). They were assessed using the Clinical Global Impression (Severity at baseline, Improvement after treatment), and the Children’s Global Assessment Scale (C-GAS). ResultsWe found a clinically meaningful improvement in most patients (CGI-I 3 or lower; 79 out of 123, 64.2%) and a statistically significant improvement in the overall functioning (as measured by the C-GAS; p<0.001). We found no effect of age or sex of the patient on results obtained; patients with an externalizing disorder had significantly poorer results. ConclusionOur study, although lacking a control group, supports the possibility to use short-term psychodynamic psychotherapy in the treatment of psychiatric disorders in preadolescents and adolescents affected by psychiatric disorders.

An undermined therapeutic alliance: A case study

Seeking help and assistance can prove to be a frustrating experience for intersex individuals: physicians and psychologists can be misinformed about variations of sex characteristics (VSC) and their practice may have a detrimental effect on the physical and psychological wellbeing of individuals with VSC. This paper focuses on how previous negative experiences, such as early genital cosmetic surgery and unaware clinical management, could negatively affect psychotherapeutic relationships. Its principal aims are to: 1) identify which elements in clinical management of VSC may cause difficulties in building a therapeutic alliance and 2) identify which elements may promote the construction and reinforcement of the therapeutic alliance, even when a patient’s trust has been damaged by previous negative experiences. In order to explore the psychotherapeutic process with specific regard to the building of the therapeutic alliance, we report a case study whose subject is a 32-year-old man who sought legal advice for his sex reassignment process and began a brief supportive psychotherapeutic treatment. Roberto, the subject of this study, was born with VSC, was assigned the female gender and underwent genital surgery at birth. In his early childhood, he developed a male gender identity. Whenever Roberto reflected on the genital surgery that he had undergone at birth, anger and frustration pervaded his psychotherapy sessions and made it difficult to build a therapeutic alliance. However, it was possible to support Roberto in redirecting these negative affects, helping him to process them, build a therapeutic alliance, and benefit from a positive and trusting therapeutic relationship.

A feasibility study of a novel work-focused relational group CBT treatment programme for moderate to severe recurrent depression

Purpose No current psychotherapeutic intervention is designed to enhance job retention in employees with moderate–severe recurrent depression. The aim of this study is to test the feasibility of a new, interdisciplinary work-focused relational group cognitive behavioural therapy (CBT) treatment programme for moderate–severe depression. Design/methodology/approach The programme was based on a theoretical integration of occupational stress, psychological, social/interpersonal and bio-medical theories. It consisted of up to four 1:1 psychotherapy sessions; 12 work-focused, full-day, weekly CBT sessions facilitated by a cognitive behavioural therapist and occupational therapist; and up to four optional 1:1 sessions with an occupational therapist. Depression severity (primary outcome) and a range of secondary outcomes were assessed before (first CBT session) and after (twelfth CBT session) therapy using validated instruments. Findings Eight women (26–49 years) with moderate–severe depression participated. Five were on antidepressant medication. While there was no statistically significant change in Hamilton Depression Rating Scale depression scores after therapy (n = 5; p = 0.313), Beck Depression Inventory-II depression scores significantly decreased after therapy (n = 8; –20.0 median change, p = 0.016; 6/8 responses, 7/8 minimal clinically important differences, two remissions). There were significant improvements in the secondary outcomes of overall psychological distress, coping self-efficacy, health-related quality of life and interpersonal difficulties after therapy. All clients in work at the start of therapy remained in work at the end of therapy. The intervention was safe and had 100% retention. Research limitations/implications A major limitation was recruitment shortfall, resulting in a small sample of middle-aged women, which reduces representativeness and increases the possibility of methodological weaknesses in terms of the statistical analysis. A definitive trial would need much larger samples to improve statistical power and increase confidence in the findings. Another major limitation was that two of the authors were involved in delivering the intervention such that its generalisability is uncertain. Practical implications This novel programme was evaluated and implemented in the real world of clinical practice. It showed promising immediate positive outcomes in terms of depressive symptoms, interpersonal difficulties and job retention that warrant further exploration in a longer-term definitive study. Social implications Empirical studies focused on enhancing job retention in employees with moderate–severe recurrent depression are lacking, so this study was highly relevant to a potentially marginalised community. Originality/value While limited by a recruitment shortfall, missing data and client heterogeneity, this study showed promising immediate positive outcomes for the new programme in terms of depressive symptoms, interpersonal difficulties and job retention that warrant exploration in a definitive study.

Freins à l’abord des troubles du comportement alimentaire en médecine générale

IntroductionGeneral practitioners (GP) are the most suitable candidates to screen for eating disorders (ED), which affect 0.6 to 4.5% of the population over their lifetime. 13% of adolescents are concerned if we consider sub-syndromic form. The outcome of ED improves with early detection but 50% of patients are still not identified in primary care. AimTo explore GP's representations of ED and the barriers they face while broaching the subject in practice and to understand this under-screening of ED. MethodIt was a qualitative study by focus groups. The five focus-group need for data saturation were transcribed and the verbatim was double coded and analyzed by the grounded theory. ResultsThe focus on anorexia nervosa, a BED remaining unrecognized and the misidentification of obesity as an ED were the main representations of the asked GPs. They considered ED as being bound to the intimacy of patients, just as sexuality would be, they feared to be too intrusive while approaching them and to compromise the patient-doctor relationship. The time-consuming part of such consults, the unknown assessment tools, a perceived lack of communication and psychological skills, the feeling of helplessness and lack of a psychiatric support stood in the way of approaching ED in general practice. ConclusionTraining for time-saving communication techniques, organizing a dedicated screening consult, a well identified psychiatric network or free psychotherapy sessions are ways to improve screening of ED. To study how psychiatry can be more positively perceived would be a first step to overcome its induced mistrust.

Access and attitudinal barriers to engagement in integrated primary care mental health treatment for rural populations.

Compared to urban areas, rural populations are less likely to engage in mental health care. Using data from the Study to Promote Innovation in Rural Integrated Telepsychiatry, we examined the effect of rurality on engagement in mental health treatment as well as the role of potential mediators. Data were obtained from medical records and surveys. We defined rurality using the rural-urban commuting area codes. Baseline mediators included the Endorsed and Anticipated Stigma Inventory and the Assessment of Perceived Access to Care. Engagement outcomes included number of psychotherapy visits and self-reported medication use. We used path analysis to examine the relationship between rurality and engagement and the influence of mediating variables. Rural participants were less likely to initiate psychotherapy (OR = 0.49; adjusted P = .036), although rurality was not associated with number of psychotherapy sessions or medication use. Rurality was associated with a small elevation in negative beliefs about mental health, but this potential mediator was not associated with engagement. Rurality was negatively associated with lower perceived need for treatment (OR = 0.67, adjusted P = .040), which was in turn positively associated with initiating psychotherapy (OR = 1.99, adjusted P = .001). Neither rurality itself nor the potential mediators had a large effect on engagement. Federally Qualified Health Centers offering colocated and/or integrated mental health care appear to be mostly mitigating rural-urban disparities in mental health engagement. Improving rates of psychotherapy initiation for rural patients should remain a policy goal.

Walking Psychotherapy As a Health Promotion Strategy to Improve Mental and Physical Health for Patients and Therapists: Clinical Open-Label Feasibility Trial.

BackgroundPersons with mental illness are more at risk for sedentary behaviour and associated consequences. We assessed the feasibility of outdoor walking during psychotherapy sessions in an outpatient trauma therapy program to challenge sedentary behaviour.MethodsIn this pilot trial in Toronto, Canada, female therapists and patients >18 years, were encouraged to walk during 12 consecutive trauma therapy sessions. Both groups were provided wearable pedometers. We assessed protocol feasibility and desirability, and 12-week changes in patient post-traumatic stress [PTSD check-list for DSM-5 (PCL-5)], and depression, anxiety, and stress symptoms [Depression, Anxiety and Stress Scale (DASS)].Results91% (20/22) of patients approached for the study consented to participate and 17 (85%) completed follow-up questionnaires. There was walking in 132/197 (67%) of total therapy sessions (mean 7.3 out of 10.9 sessions per participant). Inclement weather was the predominant reason for in-office sessions. At 12-week follow-up, PCL-5 mean scores decreased from 38.4 [standard deviation, ((SD) 11.8) to 30.7 (SD 14.7)], [mean difference (MD) 7.7, 95% CI: 1.5 to 13.8]; 41% (7/17) participants had a clinically significant PCL-5 score reduction of >10 points. DASS-stress mean scores decreased from 19.0 to 16.0 (MD 3.0, 95% CI: 0.3 to 5.6). No changes were observed for DASS depression (MD -0.9, 95% CI: −5.1 to 3.3) nor DASS anxiety (MD -0.2, 95% CI: −3.1 to 2.7). Daily step reporting was inconsistent and not analyzed. There was high acceptability amongst patients and therapists to walk, but not to record daily steps. There were no adverse outcomes.ConclusionsIt was feasible and acceptable to incorporate outdoor walking during trauma therapy sessions for patients and therapists. Weather was the greatest barrier to implementation. Further randomized-control study to compare seated and walking psychotherapy can clarify if there are psychotherapeutic and physical benefits with walking.

Association of treatment procedures and resilience to symptom load three-years later in a clinical sample of adolescent psychiatric patients

BackgroundWe aimed to examine symptom load in a clinical adolescent population at three-year follow-up and explore associations with standard care treatment procedures and resilience factors upon first presenting at Child and Adolescent Mental Health Services.MethodsThis study is part of a prospective longitudinal cohort study: The Health Survey in Department of Children and Youth, St. Olavs hospital, Norway. A clinical population of 717 (43.5% of eligible) adolescents aged 13–18 years participated in the first study visit (T1, 2009–2011). Of these, 447 adolescents with psychiatric disorders, with treatment history from medical records and self-reported resilience factors (Resilience Scale for Adolescents; READ) at T1, reported symptom load (Achenbach System of Empirically Based Assessment - Youth Self Report; YSR) three years later aged 16–21 years (T2).ResultAt T1, 93.0% received individual treatment. The frequency of psychotherapy and medication varied by disorder group and between genders. Overall, psychotherapy was more frequent among girls, whereas medication was more common among boys. Total READ mean value (overall 3.5, SD 0.8), ranged from patients with mood disorders (3.0, SD 0.7) to patients with Attention Deficit Hyperactivity disorder (3.7, SD 0.7), and was lower for girls than boys in all diagnostic groups. At T2, the YSR Total Problem mean T-score ranged across the diagnostic groups (48.7, SD 24.0 to 62.7, SD 30.2), with highest symptom scores for those with mood disorders at T1, of whom 48.6% had T-scores in the borderline/clinical range (≥60) three years later. Number of psychotherapy sessions was positively associated and Total READ score was negatively associated with the YSR Total Problems T-score (regression coefficient β = 0.5, CI (0.3 to 0.7), p < 0.001 and β = − 15.7, CI (− 19.2 to − 12.1), p < 0.001, respectively). The subscale Personal Competence was associated with the lowest Total Problem score for both genders.ConclusionsSelf-reported symptom load was substantial after three years, despite comprehensive treatment procedures. Higher self-reported resilience characteristics were associated with lower symptom load after three years. These results highlight the burden of adolescent psychiatric disorders, the need for extensive interventions and the importance of resilience factors for a positive outcome.

Spanish Versions of the Outcome Rating Scale and the Session Rating Scale: Normative Data, Reliability, and Validity.

Routine outcome monitoring (ROM) uses standardized measures to both track and inform mental health service delivery. Use of ROM has been shown to improve the outcome of psychotherapy when applied to different types of patients. The present research was designed to determine the reliability and validity of the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) in a sample of Spanish patients. After a controlled process of translation into the Spanish that is spoken and written in Spain (i.e., in Europe, as distinct from, e.g., Latin American Spanish), both measures were completed by patients of an outpatient mental health unit during eight sessions of psychotherapy. Sixty mental health patients filled out the ORS and 59 the SRS. In addition, the ORS was completed by 33 people who constituted the non-clinical sample. The cut-off of the ORS was 24.52 points, and the Reliable Change Index (RCI) was 9.15 points. ORS and SRS scores exhibited excellent internal consistency. The temporal stability of the SRS was adequate. The convergent and discriminant validity of the two measures were adequate. Regarding the factorial validity of the ORS and the SRS, in the third psychotherapy session, confirmatory factor analyses evidenced the existence of a unifactorial model. The predictive validity of SRS was acceptable. The ORS was sensitive to changes in patients’ symptoms. In conclusion, compared to the original English versions of the ORS and SRS measures, the Spanish versions of the measures are also reliable and valid.