Reliable Change Index Research Articles

Comparative retrospective analysis: exploring the quality of life of people with epilepsy in two cohorts

People with epilepsy (PWE) are reported to have a lower quality of life (QOL). QOL among PWE were primarily observed through cross-sectional studies, and there is little information about the progression of QOL among PWE over the years. This study aimed to investigate the changes in QOL among PWE at a tertiary referral centre. A retrospective observational study was conducted among PWE from the Neurology clinic at the University Malaya Medical Centre. Data were extracted from the Quality of Life in Epilepsy Inventory (QOLIE-31) database for 2016, 2017, and 2020. A total of 88 subjects were included in Cohort 1 (2016 vs. 2017) and Cohort 2 (2017 vs. 2020), respectively. There was a significant improvement in mean scores of QOLIE-31 in Cohort 1 (57.7±12.2 vs. 63.2±14.2; p<0.001), in terms of seizure worry, emotional well-being, cognitive functioning, medication effects and social function (p<0.05, respectively). However, significant deterioration was observed in Cohort 2 (67.1±15.6 vs. 63.1±14.9; p=0.008), in terms of seizure worry and cognitive functioning (p<0.05, respectively). Based on the calculated Jacobson Reliable Change Index (RCI) for the QOLIE-31 score, 28.4% from Cohort 2 experienced deterioration of QOL as compared to those from Cohort 1 (8%) (p<0.001), which was most likely attributed to the COVID-19 pandemic. This study provides insights into the change of QOL among PWE in Malaysia over time, encompassing the COVID-19 pandemic period.

Impact of trametinib on the neuropsychological profile of NF1 patients.

The use of trametinib in the treatment of pediatric low-grade gliomas (PLGG) and plexiform neurofibroma (PN) is being investigated in an ongoing multicenter phase II trial (NCT03363217). Preliminary data shows potential benefits with significant response in the majority of PLGG and PN and an overall good tolerance. Moreover, possible benefits of MEK inhibitor therapy on cognitive functioning in neurofibromatosis type 1 (NF1) were recently shown which supports the need for further evaluation. Thirty-six patients with NF1 (age range 3-19 years) enrolled in the phase II study of trametinib underwent a neurocognitive assessment at inclusion and at completion of the 72-week treatment. Age-appropriate Wechsler Intelligence Scales and the Trail Making Test (for children over 8 years old) were administered at each assessment. Paired t-tests and Reliable Change Index (RCI) analyses were performed to investigate change in neurocognitive outcomes. Regression analyses were used to investigate the contribution of age and baseline score in the prediction of change. Stable performance on neurocognitive tests was revealed at a group-level using paired t-tests. Clinically significant improvements were however found on specific indexes of the Wechsler intelligence scales and Trail Making Test, using RCI analyses. No significant impact of age on cognitive change was evidenced. However, lower initial cognitive performance was associated with increased odds of presenting clinically significant improvements on neurocognitive outcomes. These preliminary results show a potential positive effect of trametinib on cognition in patients with NF1. We observed significant improvements in processing speed, visuo-motor and verbal abilities. This study demonstrates the importance of including neuropsychological evaluations into clinical trial when using MEK inhibitors for patients with NF1.

The reliability, validity and clinical utility of the Clinical Outcomes in Routine Evaluation – ten-item version (CORE-10) in post-acute patients with stroke

Objective To explore the validity, reliability, and clinical utility of the Clinical Outcomes in Routine Evaluation – ten-item version (CORE-10: a ten-item questionnaire designed to measure psychological distress) in a stroke inpatient sample and calculate reliable and clinically significant change scores. Setting A post-acute stroke rehabilitation ward in the East of England. Participants A total of 53 patients with stroke, capable of completing the CORE-10 as part of their routine clinical assessment. Exclusion criteria included moderate to severe aphasia and/or alexia. Main measures Alongside the CORE-10, the Patient Health Questionnaire – 9, the Hospital Anxiety and Depression Scale, the Centre for Epidemiological Studies-Depression Scale, and the Beck Depression Inventory Second Edition were used as concurrent measures. Results To assess reliability, the internal consistency and test–retest reliability of the CORE-10 were calculated. The average number of days between CORE-10 test–retest administrations was 2.84 (SD = 3.12, Mdn = 1). Concurrent validity was assessed by examining correlations between the CORE-10 and comparable measures, and clinical utility was assessed using the criteria of Burton and Tyson (2015). The internal consistency (Cronbach’s alpha) for the CORE-10 was .80, and test–retest reliability interclass correlation coefficient was .81. Total score correlations between the CORE-10 and concurrent measures ranged from r = .49 to r = .89. The CORE-10 achieved the maximum score (i.e. 6/6) on criteria for clinical utility. Calculations demonstrated a reliable change index of nine points and a clinically significant change cut point of 12 on the CORE-10. Percentiles for CORE-10 total scores are reported. Conclusions This study provides preliminary support for the CORE-10 as a valid and reliable measure that has clinical utility for screening distress in inpatients with stroke.

Effectiveness of mindful self-compassion therapy on psychopathology symptoms, psychological distress and life expectancy in infertile women treated with in vitro fertilization: a two-arm double-blind parallel randomized controlled trial

ObjectivesInfertility is a prominent problem affecting millions of couples worldwide. Recently, there has been a hightened emphasis on elucidating the subtle linkages between infertility treatment leveraging assisted reproductive technology and the complex realm of psychological challenges, as well as efforts in implementation of psychological interventions.The Mindful Self-Compassion (MSC) program seeks to improve self-compassion, compassion for others, mindfulness, and life satisfaction while reducing depression, anxiety, and stress. In the current study, an MSC intervention was performed on infertile women (IW) undergoing in vitro fertilization (IVF) to assess the effectiveness of this intervention in reducing psychological distress and psychopathological symptoms and enhancing life expectancy.MethodsFifty-seven IW undergoing IVF were randomly allocated to two groups: MSC (n = 29) or treatment as usual (TAU; n = 28). Participants in MSC met once a week for two hours for eight weeks and attended a half-day meditation retreat. The Synder's Hope questionnaire and the Revised 90-Symptom Checklist (SCL-90-R) were used as the primary outcome measures. Data were obtained before the intervention, immediately after the intervention, and two months post-intervention. Repeated measures of ANCOVA and paired t-tests in all assessment points were used to compare the MSC and the TAU groups in outcomes.ResultsIn the MSC group, hopelessness, anger-hostility, anxiety, interpersonal sensitivity difficulties, and depression were significantly reduced compared with the TAU group, and those improvements persisted at the two-month follow-up. Reliable change index revealed that the MSC group's gains were both clinically significant and durable.ConclusionsMSC can facilitate higher life satisfaction and mental well-being for IW undergoing IVF by reducing psychological distress, psychopathological symptoms, and hopelessness. These encouraging findings call for more research into the effectiveness of mindfulness-based therapies in addressing psychological problems among IW undergoing IVF.

Effectiveness of Day Treatment Group Schema Therapy for Personality Disorders: A Multiple Baseline Single-Case Study.

Schema therapy is effective for most outpatients with personality disorders (PDs). However, a subgroup does not sufficiently benefit from outpatient programmes. Despite its common clinical use, a thorough evaluation of day treatment group schema therapy (GST) is lacking. This study aimed to investigate the effectiveness of day treatment GST for patients with PDs. Negative core beliefs were the primary outcome in a multiple baseline single-case design, measured weekly before and during 30 weeks of day treatment GST. Secondary outcomes included severity of primary PD, early maladaptive schemas (EMS), schema modes and general psychopathology measured before and after day treatment GST. Intervention effects were evaluated through visual inspection and randomization test analysis, with a reliable change index calculated for the secondary outcome measures. A total of 79% of treatment completers showed a significant positive effect of day treatment GST with large effect sizes (Cohen's d: 0.96-10.04). Secondary outcomes supported these findings: 56% had a significant decrease in the severity of primary PD and 53% in general psychopathology. In addition, 63% of EMS and 72% of schema modes (87.5% for functional schema modes) showed significant positive reliable changes. This is the first empirical study that demonstrated the effectiveness of day treatment GST in patients with severe PDs. Day treatment GST can serve as a stepped care treatment option for nonresponsive patients in outpatient programmes. Further randomized controlled (cost-)effectiveness research is necessary to substantiate these findings and investigate the specific patient populations for which day treatment is essential.

Test–retest reliability and reliable change index of the Philips IntelliSpace Cognition digital test battery

Objective This article provides the test–retest reliability and Reliable Change Indices (RCIs) of the Philips IntelliSpace Cognition (ISC) platform, which contains digitized versions of well-established neuropsychological tests. Method 147 participants (ages 19 to 88) completed a digital cognitive test battery on the ISC platform or paper-pencil versions of the same test battery during two separate visits. Intraclass correlation coefficients (ICC) were calculated separately for the ISC and analog test versions to compare reliabilities between administration modalities. RCIs were calculated for the digital tests using the practice-adjusted RCI and standardized regression-based (SRB) method. Results Test–retest reliabilities for the ISC tests ranged from moderate to excellent and were comparable to the test-retest reliabilities for the paper-pencil tests. Baseline test performance, retest interval, age, and education predicted test performance at visit 2 with baseline test performance being the strongest predictor for all outcome measures. For most outcome measures, both methods for the calculation of RCIs show agreement on whether or not a reliable change was observed. Conclusions RCIs for the digital tests enable clinicians to determine whether a measured change between assessments is due to real improvement or decline. Together, this contributes to the growing evidence for the clinical utility of the ISC platform.

The effectiveness of acceptance and commitment therapy (ACT) on neurotic perfectionism and internalized self-criticism in neurotic perfectionist girls: A single-case experimental study

Introduction: Neurotic perfectionism has a variety of psychological consequences that should be considered in psychotherapy applications. Aim: The present study aimed to examine the effectiveness of acceptance and commitment therapy (ACT) on neurotic perfectionism and internalized self-criticism in neurotic perfectionist girls. Method: This study was conducted using a single-case quasi-experimental design with, concurrent multiple baseline. The research population consisted of neurotic perfectionist girls visiting counseling centers in Ahvaz in 2022. The participants were a sample of 5 girls selected using purposive sampling with a minimum cut-off score of 145 in the Neurotic Perfectionism Questionnaire (NPQ). The acceptance and commitment therapy (ACT) (Twohig & et al, 2021) was implemented in eleven 90-minute sessions. The participants completed the Neurotic Perfectionism Questionnaire (1994), and the Levels of Self-Criticism Scale (2004). The data were collected in three baseline, intervention, and three-month follow-up phases and analyzed using reliable change index (RCI), recovery percentage, and visual inspection. Results: The analysis of the recovery percentage showed the participants’ neurotic perfectionism 17.67 and internalized self-criticism 19.73 improved in the intervention phase and their neurotic perfectionism 36.25 and internalized self-criticism 49.90 increased in the follow-up phase. Moreover, the reliability change index of both variables in the post-treatment and follow-up phases was significant (P=0.05). Conclusion: Considering the effectiveness of acceptance and commitment therapy in reducing neurotic perfectionism and internalized self-criticism by increasing psychological flexibility, this therapy can be used as an intervention method in neurotic perfectionist girls.

Adherence to the MIND diet and the odds of mild cognitive impairment in generally healthy older adults: The 3-year DO-HEALTH study

BackgroundThe Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet may slow cognitive decline in older adults. A potential mechanism could be possible anti-inflammatory properties of the MIND-diet. ObjectiveTo examine whether adherence to the MIND diet at baseline is associated with the odds of mild cognitive impairment (MCI) and changes in biomarkers of inflammation (High-sensitivity C-reactive Protein(hsCRP), interleukin-6(IL-6)) over three years in adults ≥70 years. MethodsAdherence to the MIND diet was assessed by food frequency questionnaire (FFQ) at baseline and after three years. Presence of MCI based on the Montreal Cognitive Assessment (MoCA) was defined as <26 (MCI26), or <24 (MCI24). We performed a minimally adjusted model controlling for sex, prior fall, linear spline at age 85, time, treatment and study site. The fully adjusted model also adjusted for education, BMI, physical activity, depression score, daily energy intake, and comorbidity score. To assess the change in inflammatory markers from baseline, we used linear-mixed-effect models adjusted for the same variables plus the respective baseline concentrations. Sensitivity analyses accounting for practice effects of repeated cognitive tests using the reliable change index for both MoCA cut-offs were done. ResultsWe included 2028 of 2157 DO-HEALTH participants (60.5% women; mean age 74.88 years) with complete data. Adherence to the MIND diet at baseline was not associated with cognitive decline over three years, neither at MoCA < 26 (OR (95%CI) = 0.99 (0.94–1.04)) nor at MoCA < 24 (OR (95%CI) = 1.03 (0.96–1.1)). Applying the reliable change index to the two cut-offs confirmed the findings. Further, the MIND diet adherence was not associated with the change in MoCA score from baseline in DO-HEALTH. For inflammatory biomarkers MIND-diet baseline adherence was not associated with changes in hsCRP or IL-6. ConclusionAdherence to the MIND-diet was neither associated with the odds of MCI, nor with hsCRP or IL-6 at baseline. Moreover, change in MIND-diet over three years was not associated with changes in hsCRP or IL-6.

Treatment of chronic symptoms following mild traumatic brain injury with transcranial LED: a sham run-in pilot study of photobiomodulation therapy

ABSTRACT Primary Objective We evaluated whether photobiomodulation with red/near infrared light applied transcranially via light emitting diodes (LED) was associated with reduced symptoms and improved cognitive functioning in patients with chronic symptoms following mild traumatic brain injury. Research Design Participants (3 men, 6 women; 22–61 years-old) underwent a 6-week intervention involving 18 40-minute transcranial LED treatment sessions. Methods and Procedures Reliable change indices were calculated for 10 neuropsychological test scores and 3 self-report questionnaires of subjective cognition, post-concussion symptoms, and depression at baseline and following treatment. Questionnaires were also administered after 2-week sham and at 1-month and 2-month follow-ups. Main Outcome and Results Only 2 participants improved on neuropsychological testing. On questionnaires, 4 reported improved cognition, 5 reported improved post-concussion symptoms, and 3 reported improved depression. Significant improvement in 2 or more domains was reported by 4 participants and mostly maintained at both follow-ups. Conclusions Most participants did not improve on neuropsychological testing. A minority self-reported improvement in symptoms, potentially explained by the intervention, psychiatric medication changes, placebo effects, or other factors. Selecting participants with different clinical characteristics, and dosing and delivery system changes, may produce different results. A study design accounting for placebo effects appears warranted in future trials.

Key Questions on the Long-Term Utility of Methylphenidate in Paediatric Brain Tumour Survivorship: A Retrospective Clinical Case Series.

Methylphenidate has an established role in the management of attention-deficit hyperactivity disorder and attentional deficit secondary to brain injury. Increasingly, methylphenidate is considered for the attentional deficit in paediatric brain tumour survivors. A small number of studies have explored the benefit of methylphenidate in this population; however, studies are of short duration and do not address the impact of medium to long-term use of methylphenidate on intellectual function. We identified six patients who are survivors of a paediatric brain tumour aged 12-18 years with greater than three years of use of methylphenidate for inclusion in a clinical case series. We used this patient cohort to identify key questions to inform a future long-term cohort study. Linear mixed model and reliable change index analyses were performed on the data. Reliable change index analyses showed benefits to working memory (n = 3), processing speed (n = 2), and full-scale IQ (n = 4) performance for some patients. This exploratory case series suggests the potential medium to long-term benefit of methylphenidate in brain tumour survivorship, indicating the need for larger, appropriately powered studies. These patient data, alongside a discussion of learning points from our previously published studies, are used as a conduit for the identification of questions relating to the use of methylphenidate in a paediatric brain tumour.

TEST-RETEST RELIABILITY AND RELIABLE CHANGE INDEX OF MOBILE APPLICATION NEUROCOGNITIVE TEST AMONG MIDDLE AND HIGH SCHOOL ATHLETES.

A mobile application neurocognitive assessment has been used in place of equipment intensive computerized neurocognitive assessment protocol. A previous study reported high to very high test-retest reliability of neurocognitive assessment using the mobile application in healthy adults, but no studies have examined test-retest reliability, reliable change indices (RCIs), and sex effect in middle school and high school populations when conducted 1 year apart. The purpose of this study was to examine the test-retest reliability and RCIs of baseline data collected at 2-time points approximately 1 year apart using a mobile application neurocognitive rest in middle school and high school athletes. The secondary purpose of the study was to investigate the sex difference in neurocognitive measures. Cross-sectional study. Institutional. 172 middle school and high school healthy student-athletes (mean age=13.78±1.59 years old). Mobile application neurocognitive rest scores (reaction time, impulse control, inspection, and memory). The result from the study demonstrated that neurocognitive measures had low test-retest reliability across a 1-year time period in middle and high school settings. Upon retesting, reaction time and inspection time improved significantly in both middle and high school athletes, and impulse control showed significant improvement in middle school athletes. More athletes in middle school showed more RCI improvements compared to high school athletes. While both males and females demonstrated improvements in neurocognitive measures throughout adolescence, males outperformed females on reaction time and impulse control. Findings from the study indicate unacceptably low test-retest reliability of a mobile application neurocognitive test most likely due to cognitive development occurring throughout adolescence. Additionally, significant RCIs were noted. These naturally occurring improvements due to cognitive development could mask the post-concussion deficits. The findings warrant consideration of age and sex on the neurocognitive performance of middle and high school athletes.

Establishing the Minimally Important Difference for the KOOS-Joint Replacement and PROMIS Global-10 in Patients After Total Knee Arthroplasty.

Despite the overall prevalence and success of total knee arthroplasty (TKA), a significant portion of patients are dissatisfied with their outcomes. To assess the responsiveness and determine the minimally important difference (MID) of 2 patient-reported outcome measures (PROMs)-the Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) and the Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS 10)-in patients after TKA. Cohort study (diagnosis); Level of evidence, 3. Included were patients who underwent TKA from August 2015 through August 2019 and completed baseline and postoperative KOOS-JR and PROMIS 10 surveys. The PROMIS 10 consists of 2 domains: physical health and mental health. Estimates for the reliable change index (RCI) and MID, using anchor-based and distribution-based methods, were calculated for each PROM. Regression modeling was used to determine whether patient and clinical factors predicted MID thresholds or MID achievement. A total of 1315 patients were included. Distribution-based MIDs, calculated using various methods from baseline scores, ranged from 19.3 to 31 for the KOOS-JR, and the RCI was 4.38. Of these patients, 293 (22.3%) demonstrated small or moderate improvement, and this cohort was included in the calculation of anchor-based MIDs. The anchor-based MIDs were 16.9 and 24.3 at 3-month and 1-year follow-up, respectively, and 66% of patients achieved the MID at 12 months. Higher preoperative PROM score, male sex, non-White race, and current smoker status were predictive of failing to achieve the anchor-based MID for KOOS-JR at 1 year postoperatively (P < .05). Higher preoperative PROM score and any 90-day adverse event predicted lower thresholds of important change in anchor-based MIDs. Higher baseline PROM scores, younger age, male sex, non-White ethnicity, higher American Society of Anesthesiologists classification, preoperative narcotics use, not smoking, and longer hospital stay were all associated with lower odds of achieving the MID on the KOOS-JR or either of the PROMIS 10 subscales. The study results demonstrated relevant values for interpretation of the KOOS-JR and PROMIS 10. While patient demographics did not accurately predict which patients would achieve the MID, some potential factors predicting successful patient-reported outcomes after TKA were identified.

The Duration-Adjusted Reliable Change Index: Defining Clinically Relevant Symptom Changes of Varying Durations.

The time period over which relevant symptoms shifts unfold is not uniform across individuals. This article proposes an adaptation of the Reliable Change Index (RCI) to detect symptom changes of varying durations in individual patients' time series: the Duration-Adjusted RCI (DARCI). The DARCI proportionally raises the RCI cut-off to account for its extension over additional time increments, resulting in different DARCI thresholds for different change durations. The method is illustrated with a simulation study of depressive symptom time series with varying degrees of discontinuity and overall mean change, and four empirical case examples from two clinical samples. The results suggest that the DARCI may be particularly useful for identifying symptom shifts that appear relatively abrupt, which can help indicate when a patient is showing significant improvement or deterioration. Its ease of use makes it suitable for application in clinical contexts and a promising method for exploring transitions in psychiatric populations.

Sensitivity to change in well-being and health-related quality of life in adults with eating disorder symptoms: ICECAP-A versus EQ-5D-5L.

Economic evaluations of treatments help to inform decisions on allocating health care resources. These evaluations involve comparing costs and effectiveness in terms of quality of life. To calculate quality-adjusted life years, generic health related quality of life is often used, but is criticized for not being sensitive to change in mental health populations. Another approach, using experienced well-being measured through capabilities with the ICECAP-A, has been proposed as an alternative. The aim of this study was to investigate whether changes in individuals with eating disorder (ED) symptoms can be better captured using health related quality of life (EQ-5D-5L) or well-being (ICECAP-A). Measurements at two time points with an interval of 1 year were used from a sample of 233 participants with self-reported ED symptoms. An analysis of variance was used to test whether the EQ-5D-5L and ICECAP-A differed in sensitivity to change over time. In order to compare the two questionnaires in terms of clinically significant outcome, the reliable change index and clinical cut-off score were calculated. The two questionnaires did not differ in sensitivity to change. More individuals had recovered but also more had deteriorated according to the EQ-5D-5L compared to the ICECAP. The present study revealed no differences in sensitivity to change in health-related quality of life or well-being in individuals with ED symptoms in the context of mild clinical change. Results corroborated the pervasiveness of low quality of life in this population, even after alleviation of ED symptoms. Measuring treatment benefits in terms of improvements in quality of life is an integral part of economic evaluations in health care. It was expected that these treatment benefits would be better captured as changes in well-being (measured with the ICECAP-A) than as changes in health-related quality of life (measured with the EQ-5D-5L) for individuals with ED symptoms. Based on the results of this study, no preference for one of the two approaches was found.

Functional neuroimaging and behavioral correlates of multisite tDCS as an add-on to language training in a person with post-stroke non-fluent aphasia: a year-long case study

ABSTRACT Mary, who experienced non-fluent aphasia as a result of an ischemic stroke, received 10 years of personalized language training (LT), resulting in transient enhancements in speech and comprehension. To enhance these effects, multisite transcranial Direct Current Stimulation (tDCS) was added to her LT regimen for 15 sessions. Assessment using the Reliable Change Index showed that this combination improved her left inferior frontal connectivity and speech production for two months and significantly improved comprehension after one month. The results indicate that using multisite transcranial direct current stimulation (tDCS) can improve the effectiveness of language therapy (LT) for individuals with non-fluent aphasia.

Benefits of the Growing up Together Online Parenting Program for Families in Social Services in Croatia

Parenting programs have the ability to enhance parenting quality and healthy child development, but the overwhelming majority of evidence for their effects comes from a small minority of countries and research-intensive contexts. More evidence is needed from effectiveness studies (rather than highly controlled efficacy studies) and from countries less well-represented in the international literature. We examined changes in parental cognitions and parenting behavior in 62 families completing a 10-week online group program (Growing up Together Online) as part of social services in Croatia in 2020 and 2021, during the Covid-19 pandemic and earthquake. Parents reported on their cognitions and behaviors before and after the intervention. Paired-sample t-tests show significant improvements in parent-reported general self-esteem, parenting self-efficacy, and parenting experience and morale. Parents also reported significant reductions in angry, harsh, and violent parenting. Parents did not report increased attempts to understand children’s perspectives and positive interactions (e.g. joint play). Reliable change index analysis showed that reliable improvement was most common in parenting self-efficacy and least common in positive involvement and reinforcement. Findings provide preliminary evidence for the program’s potential to optimize the parenting conditions of children growing up in an environment at risk for child abuse and neglect.

Effectiveness of a Communication Skills Training Protocol on Improving Marital Burnout

Objective: The aim of this research was to investigate marital burnout and to determine the effectiveness of a communication skills training protocol. Methods: The experimental method employed was a single-subject design with multiple baselines, involving couples seeking counseling at the Raz City Clinic in Shiraz and the Clinic of the General Directorate of Exceptional Education in Fars Province, during the autumn of 2021. Among these couples, three pairs exhibiting the highest levels of marital burnout were selected using a purposive sampling method. The therapeutic program of the communication skills training protocol was conducted by the researcher over 10 sessions, followed by a follow-up in two stages, one month apart. The participants responded to the Marital Burnout Scale at the baseline, post-treatment, and follow-up stages. Data were analyzed using visual analysis methods, the recovery percentage formula, and the reliable change index. Findings: Findings indicated that the communication skills training protocol enhanced marital quality and reduced marital burnout, with these effects being maintained during the follow-up phase. Conclusion: The treatment protocol proved to be effective, and couple therapists can utilize these communication skills in their work with couples to reduce marital burnout and enhance marital quality, particularly during the early years of marriage, where it can have a significant impact.

"The early bird catches the worm"-Prediction of early response and its importance for treatment outcome in a naturalistic setting of cognitive behaviour therapy.

Knowledge about predictors of early response (ER) remains limited. This study examined patient, process, and therapist variables to predict ER in a naturalistic setting. Data from 493 psychotherapy outpatients were analysed. ER was defined by a ≥25% reduction in general psychological distress (ER percent) and by the reliable change index (ER RCI) within the first 10 sessions measured by the Brief Symptom Inventory-18. ER prediction was determined using logistic regression. General psychological distress (GSI) throughout treatment in patients with and without ER was modelled using a multilevel linear model. This model aimed to predict GSI over treatment using repeated measurements, considering group affiliation (ER percent vs. no ER percent), controlled for other predictors. The prevalence of ER percent and ER RCI were 63.6% and 47.5%, respectively. GSI and therapeutic relationship significantly predicted ER (ER percent: χ2 (6) 70.32, p < .001, Nagelkerkes R2 = .19; ER RCI: χ2 (6) 134.71, p < .001, Nagelkerkes R2 = .35). Patients who rated the therapeutic relationship more positively were more likely to achieve ER (OR = 1.10). Difference in outcomes between patients with and without ER during treatment was influenced by factors such as therapeutic relationship, GSI, therapist experience, and mental comorbidities. Including these variables improved the predictive model from AIC = 17,042.98 to AIC = 16,730.24. The therapeutic relationship is a crucial predictor of ER. Patients achieving ER tend to have better outcome than those without ER. The early phase of therapy warrants particular attention to enhance psychotherapy outcomes.

Effectiveness of the Self-Harmonization Counseling Model Based on the Sharing Approach in Reducing Mother-Adolescent Conflicts: A Case Study

Objective: This study aims to evaluate the effectiveness of the self-harmonization counseling model based on the sharing approach in reducing mother-adolescent conflicts. Methods and Materials: The research method was quasi-experimental, employing case studies. For this purpose, three mother-adolescent pairs, characterized by non-sharing, high-conflict mothers, were selected in 2022 from Tehran using purposive sampling based on entry criteria. Over the course of eight 60-minute sessions, they underwent counseling using a sharing-focused self-harmonization model. Mothers and adolescents completed the Parent-Adolescent Conflict Questionnaire by Asadi Younesi et al. (2011) at baseline and intervention stages, while only mothers responded to the Sharing Lifestyle Questionnaire by Esmaeili et al. (2022) during these phases. Additionally, before treatment, both mothers and adolescents filled out the General Health Questionnaire GHQ-28 (Goldberg &amp; Hillier, 1979). Data were analyzed using visual plotting, reliable change index, and percentage of improvement formula. Findings: The results indicated that the overall percentage of improvement in conflict post-intervention from the perspectives of parents and adolescents was 58.11% and 42.17% for the first participant, 47.01% and 37.13% for the second participant, and 28.29% and 27.75% for the third participant, respectively. Also, the increase in sharing by mothers was 62.23%, 51.88%, and 34.76% for the first, second, and third participants, respectively. These values represent successful short-term counseling outcomes. Conclusion: Therefore, the self-harmonization model based on the sharing approach provides an opportunity for mothers to foster self-harmonization across various dimensions by adopting a sharing attitude and implementing productive strategies, thereby experiencing reduced conflicts with their adolescents. The findings can be utilized by counselors in the fields of family and adolescent.

Effectiveness of Short-term Intensive Dynamic Psychotherapy on the Severity of Gastrointestinal Symptoms and Depression in Patients with the Diarrhea Subtype of Irritable Bowel Syndrome

Objective: Irritable Bowel Syndrome (IBS) is one of the functional gastrointestinal disorders and the most common digestive disorder. The purpose of the current study was to investigate the effectiveness of short-term intensive dynamic psychotherapy on the severity of gastrointestinal symptoms and depression in patients with the diarrhea subtype and concurrent depression of Irritable Bowel Syndrome. Methods and Materials: The present study employed a single-case quasi-experimental design. Three patients with the diarrhea subtype and concurrent depression of Irritable Bowel Syndrome, who had visited neurology and psychiatry clinics in Qom in December 2023, were selected through purposive sampling and each received 18 sessions of short-term intensive dynamic psychotherapy. Data derived from the Somatic Symptom Scale by Solati Dekordi et al. (2009) and the Beck Depression Inventory-II (BDI-II) by Beck et al. (1996) were recorded at three stages (baseline, treatment, and follow-up) and analyzed using visual plotting methods, the Reliable Change Index, and the percentage of improvement formula. Findings: The percentage of improvement in the severity of gastrointestinal symptoms and the severity of depression symptoms for each patient in the treatment and follow-up stages was higher than 50%, indicating therapeutic success. The Reliable Change Index for the severity of gastrointestinal symptoms and depression severity for all three patients was above 1.96, indicating significant improvement. Conclusion: Short-term intensive dynamic psychotherapy appears to be effective in reducing the severity of gastrointestinal symptoms and depression in these patients. Therefore, it is recommended that randomized controlled trials with long-term follow-up be conducted as a continuation of this preliminary study.