Treatment Attendance Research Articles

Understanding the Shared Meaning of Recovery From Substance Use Disorders: New Findings From the What is Recovery? Study.

Substance use disorder (SUD) resolution typically involves a long-term, comprehensive process of change now widely referred to as "recovery." Yet, definitions of recovery vary substantially, producing significant confusion. To support formal recovery definitions, we aimed to systematically identify recovery elements that are central to those in recovery and shared regardless of subgroup/pathway. Data were from the What is Recovery? Study, involving a diverse, national, online survey of people in recovery (N = 9341). Surveys included a 35-item recovery measure reflecting 4 domains; participants reported whether or not each element definitely belonged in their recovery definitions. Analyses examined item endorsements overall and among 30 subgroups defined a priori (by sociodemographics, substance use characteristics, and help-seeking history) to determine where items met study-specific centrality thresholds (ie, endorsement by ⩾80% and top-10 ranking, by endorsement level). We then classified items as "core" if meeting centrality thresholds both overall and for all 30 subgroups, and "prevalent" if meeting centrality thresholds overall and for 26 to 29 subgroups. Four "core" recovery elements emerged, including a process of growth or development; being honest with oneself; taking responsibility for the things one can change; and reacting in a more balanced way. Four "prevalent" recovery elements also emerged, referencing the ability to enjoy life and handle negative feelings without substance use; abstinence and/or nonproblematic substance use; and living a life that contributes. Subgroups differing most in their endorsements included those reporting mild/moderate SUD severity; non-abstinent recovery; and no specialty treatment or mutual-help group attendance. Recovery elements identified here partially reflect some stakeholder definitions, but offer greater specificity and include novel elements (eg, personal integrity). Elements may point to areas of functioning that are damaged in the addiction process and can support an addiction-free life. Findings should inform institutional recovery definitions; SUD services and research; and communications about recovery.

Virtual fall program assessment for frail Canadian community-dwelling older adults: Examining equitable accessibility.

In response to COVID-19, the fall prevention program (FPP) at Sunnybrook Health Sciences Centre was modified to be delivered virtually. We compared patient populations assessed for the FPP virtually versus in-person to explore equitable accessibility. A retrospective chart review was performed. All patients assessed virtually from the beginning of the COVID-19 pandemic until the end of abstraction (April 25, 2022) were compared to a historic sample of patients assessed in-person beginning in January 2019. Demographics, measures of frailty, co-morbidity, and cognition were abstracted. Wilcoxon Rank Sum tests and Fisher's Exact tests were used for continuous and categorical variables, respectively. Thirty patients were assessed virtually and compared to 30 in-person historic controls. Median age was 80 years (interquartile range 75-85), 82% were female, 70% were university educated, the median Clinical Frailty Score was 5 out of 9, and 87% used >5 medications. Once normalized, frailty scores showed no difference (p = 0.446). The virtual cohort showed significantly higher outdoor walking aid use (p = 0.015), reduced accuracy with clock drawing (p = 0.020), and nonsignificant trends toward using >10 medications, requiring assistance with >3 instrumental activities of daily living (IADLs), and higher treatment attendance. No significant differences were seen for time-to-treat (p = 0.423). Patients assessed virtually were similarly frail as the in-person controls but had increased use of walking aids, medications, IADL assistance, and cognitive impairment. In a Canadian context, frail and high socioeconomic status older adults continued to access treatment through virtual FPP assessments during the COVID-19 pandemic highlighting both the benefits of virtual care and potential inequity.

Factors Related to Treatment Attendance for Patients Seeking Gender-Affirming Voice Therapy.

The purpose of this study was to investigate factors related to treatment attendance for patients seeking gender-affirming voice therapy (GAVT). We completed retrospective chart reviews of 50 patients (43 transgender women, three transgender men, four nonbinary patients; aged 18-67 years, M = 34.92 years, SD = 12.32 years) referred for GAVT at a Midwest outpatient center from 2016 to 2021. Data extraction included patient demographics, therapy visit specifics (e.g., number of sessions attended, treatment completion status, and in-person vs. virtual visits) and treatment timing (in relation to the onset of the COVID-19 pandemic), and psychosocial and socioeconomic information. There was no impact of treatment-timing relative to the onset of the pandemic on any attendance measure; however, patients were 1.9 times more likely to complete therapy with each virtual telehealth session attended. Individual factors of outside social support and hormone replacement therapy were positively related to the number of therapy sessions attended, whereas insurance provider and employment status were related to therapy completion. Telehealth attendance during the COVID-19 pandemic was positively associated with GAVT completion. Future research should investigate psychosocial and socioeconomic factors to understand how to identify patients at risk for poor treatment adherence and facilitate access to clinical care.

Client Views of Contingency Management in Gambling Treatment: A Thematic Analysis

Low levels of treatment access and poor retention among those with gambling problems suggests a need to improve treatment. Contingency management (CM) is a behavioural intervention involving the identification of target behaviours and the provision of incentives when targets are met. There exists a substantial evidence base for CM increasing abstinence and attendance in substance misuse treatment, but this has not been widely extended to gambling treatment setting. This study sought to explore the views of clients about CM for the treatment of problematic and disordered gambling. We conducted semi-structured interviews with 25 gambling treatment clients who were, or had previously been, engaged in treatment in Great Britain. Participants were provided with an explanation of CM, two hypothetical scenarios, and two structured questionnaires to facilitate discussion. Thematic analysis was used to interpret findings. Some participants felt that clients could manipulate CM while in treatment to obtain money to gamble, and that mechanisms of CM could trigger recovering clients into relapse. Participants also identified potential benefits of CM to achieve treatment goals, by enhancing motivation and engagement while in treatment, and helping bring people into treatment earlier. Gambling treatment clients broadly supported the use of incentives for treatment. CM is seen as a facilitator of extended engagement in treatment, and an encouragement for clients to make progress in the treatment process.

The Cost-Effectiveness of Financial Incentives to Achieve Heroin Abstinence in Individuals With Heroin Use Disorder Starting New Treatment Episodes: A Cluster Randomized Trial-Based Economic Evaluation

ObjectivesCost-effectiveness analysis of two 12-week contingency management (CM) schedules targeting heroin abstinence or attendance at weekly keyworker appointments for opioid agonist treatment compared with treatment as usual (TAU). MethodsA cost-effectiveness analysis was conducted alongside a cluster randomized trial of 552 patients from 34 clusters (drug treatment clinics) randomly allocated 1:1:1 to opioid agonist treatment plus weekly keyworker appointments with (1) CM targeted at heroin abstinence (CM abstinence), (2) CM targeted at on-time attendance at weekly appointments (CM attendance), or (3) no CM (TAU). The primary cost-effectiveness analysis at 24 weeks after randomization took a societal cost perspective with effects measured in heroin-negative urine samples. ResultsAt 24 weeks, mean differences in weekly heroin-negative urine results compared with TAU were 0.252 (95% confidence interval [CI] −0.397 to 0.901) for CM abstinence and 0.089 (95% CI −0.223 to 0.402) for CM attendance. Mean differences in costs were £2562 (95% CI £32-£5092) for CM abstinence and £317 (95% CI −£882 to £1518) for CM attendance. Incremental cost-effectiveness ratios were £10 167 per additional heroin-free urine for CM abstinence and £3562 for CM attendance with low probabilities of cost-effectiveness of 3.5% and 36%, respectively. Results were sensitive to timing of follow-up for CM attendance, which dominated TAU (better outcomes, lower costs) at 12 weeks, with an 88.4% probability of being cost-effective. Probability of cost-effectiveness remained low for CM abstinence (8.6%). ConclusionsFinancial incentives targeted toward heroin abstinence and treatment attendance were not cost-effective over the 24-week follow-up. Nevertheless, CM attendance was cost-effective over the treatment period (12 weeks), when participants were receiving keyworker appointments and incentives.

Characteristics of a Post-Coronavirus-19 Sample Undergoing Rehabilitation: An Exploratory Study

<h3>Research Objectives</h3> Describe sample presenting to a brain rehabilitation clinic with cognitive impairment after COVID-19 infection. <h3>Design</h3> Pre- and post-intervention measures from a clinical sample. <h3>Setting</h3> Outpatient Brain Rehabilitation Clinic. <h3>Participants</h3> Eight patients undergoing outpatient rehabilitation after COVID-19 infection (Mean age = 47.1, Range: 38-55 years; females = 6, males = 2; 4 hospitalized at time of acute infection, Mean time to treatment 243 days, Range: 84-415 days). <h3>Interventions</h3> Treatment by an experienced team of interdisciplinary providers with composition and treatment frequency tailored to individual needs. <h3>Main Outcome Measures</h3> Patient Health Questionnaire (PHQ-9); Participation Index of the Mayo-Portland Adaptability Inventory (M2PI); Satisfaction with Life Scale (SWLS); Neurobehavioral Symptom Inventory – 22 (NSI-22). <h3>Results</h3> Average number visits = 6.5 (Range: 0-25). Treatment attendance was close to 100%. Mean PHQ-9 on admission 10.625 (Range: 3-18) and at discharge 10.25 (Range: 1-17). Mean M2PI on admission was 13 (Range:8-24, and on discharge was 10.875 (Range: 0-20). Mean SWLS was the same at admission and discharge, 20.625 (Range: Admit: 15-29, Discharge 10-29). NSI-22 mean on admission 37.375 (Range 16-49) and on discharge 31.5 (Range:6-54). <h3>Conclusions</h3> Most of our sample reported moderate to moderate-severe depression. Most endorsed moderate-severe disability on the M2PI. This changed only slightly over treatment. This sample reported highly variable symptom complaint and life satisfaction. Of 5 patients with worsening scores over treatment, 4 were patients who started treatment well over 200 days after their initial diagnosis (Range: 229-415 days). Our treatment sample reports variable symptomatology and outcomes that may be tied to time to initiating rehabilitation. <h3>Author(s) Disclosures</h3> None.

Dropout and recidivism are partly explained by emotional decoding and perspective taking deficits of intimate partner violence perpetrators.

Professionals and researchers have dedicated important efforts to understanding the underlying factors that explain the failure to complete interventions (dropout) and the recidivism of men convicted of intimate partner violence (IPV) against their female partners. There is a growing interest in measuring emotional decoding and empathic deficits in IPV perpetrators to better understand dropout and recidivism proneness, due to their direct impact on behavioral regulation. In the current study, we first aimed to examine whether the emotional decoding abilities of facial expressions and empathic abilities (cognitive and emotional), as well as their interrelationships in IPV perpetrators (n = 561), would explain dropout, treatment attendance, and recidivism (risk and official) once treatment ended. Our results allowed us to conclude that emotional decoding abilities and perspective taking (cognitive empathy) were significantly and negatively associated with dropout and recidivism. Two moderation models were significant. On the one hand, participants with low emotional decoding abilities presented lower intervention doses the lower their perspective taking. Furthermore, the percentage of participants that reoffended was higher among individuals with low and moderate perspective taking who dropped out. Therefore, our study highlights the importance of conducting emotional decoding and empathic assessments during the initial stages of intervention programs to clearly outline the therapeutic needs of IPV perpetrators. This would allow designing coadjuvant and complementary training programs that can support the main interventions by increasing treatment adherence and, in turn, reducing the risk of recidivism.

Comparison of Regular Versus After Hours Admissions to a 24-hour Opioid Treatment Program.

October of 2017 marked the opening of the first US Opioid Treatment Program (OTP) that was staffed 24 hours a day, 7 days a week, with admissions on demand, both during normal OTP working hours and outside the hours when most OTPs are able to accept new patients. This article compares demographic and treatment outcomes for those patients admitted during normal working hours with those admitted after hours or on weekends. All admissions to the 24-hour OTP between January 2018 and December 2020 who were new to treatment at this OTP and started on methadone were included. An internal database of patient demographics and dosing events was collected during the normal treatment process. These data were examined regarding initial demographics, dosing, and treatment outcomes, comparing patients admitted during normal working hours with those admitted when most OTPs would be closed and unable to admit new patients. A total of 7,334 admissions were included, 2,631 during normal working hours, and 4,703 after hours or on weekends. After-hours patients were comparable in age but were more likely to be male (56.0% vs. 52.5%, P < 0.01), employed (24.1% vs. 22.1%, P < 0.05), and White versus non-White (56.2% vs. 51.5%, P < 0.001) compared with working-hour admissions. Outcomes of first-day dose, 30th-day dose, and 30-day treatment attendance did not differ between the 2 groups. In this situation where patients could be admitted at any time, the majority presented after hours. Patients who were admitted after-hours did not have worse treatment outcomes than those who were admitted during working hours. These findings suggest that offering OTP admission after-hours and on weekends will not result in attracting patients with low motivation and poorer outcomes than those who are admitted during working hours. Extending OTP admission hours has the potential to improve medication for opioid use disorder access and treatment outcomes.

Impact of a brief intervention to improve engagement in a recovery program for young adults with serious mental illness

ObjectiveSerious mental illnesses (SMI) commonly emerge during young adulthood. Effective treatments for this population exist; however, engagement in treatment is a persistent challenge. This study examines the impact of Just Do You (JDY), an innovative intake-focused intervention designed to improve engagement in treatment and enhance personal recovery. MethodsThe study used a parallel group randomized trial to examine if and how JDY improved recovery among 121 young adults with SMI from low-resourced communities referred to personalized recovery-oriented services (PROS). Measures of engagement (buy-in and attendance) and personal recovery in this pilot study were assessed at baseline and 3-month follow-up. ResultsParticipants in JDY reported more positive engagement outcomes; that is, relative to the control group they reported higher past two week attendance (b = 0.72, p < 0.05, Cohen's d = 0.56) and higher levels of buy-in to treatment (b = 2.42, p < 0.05, Cohen's d = 0.50). JDY also impacted young adults' personal recovery (b = 0.99, p < 0.05, Cohen's d = 1.15) and did so largely by increasing their level of buy-in to the treatment program. ConclusionThis study suggests that an engagement intervention for young adults that orients, prepares, and empowers them to be active and involved in the larger treatment program makes a difference by improving engagement and enhancing recovery. Data also support conceptualizing and examining engagement beyond treatment attendance; in this study what mattered most for recovery was the level of buy-in to treatment among young adults.

The Effects of Adverse Childhood Experiences (ACEs), Mental Illness, and Personality Differences on Attitudes Toward Self-Efficacy Among Females on Parole/Probation.

Female offenders released from prison often face challenges within the community such as lack of employment, inconsistent attendance in substance use treatment, and complying with parole and probation conditions, which typically decreases their self-efficacy and motivation to refrain from reoffending. Despite this, much is still unknown of psychological factors that could impact female offenders' attitudes toward self-efficacy, such as mental illness symptoms, Adverse Childhood Experiences (ACEs), and personality differences. Thus, this cross-sectional study explored whether mental illness symptoms, ACEs, and personality differences were associated with attitudes toward self-efficacy (N = 398). Results suggest that mental illness symptoms, ACEs, and neuroticism negatively associated with attitudes toward self-efficacy in contrast to extraversion and conscientiousness. Parole/probation reentry and therapeutic implications are discussed.

64 Impact of Substance Use Navigators on Addiction Treatment and Outcomes for Emergency Department Patients in an Integrated Public Health System

64 Impact of Substance Use Navigators on Addiction Treatment and Outcomes for Emergency Department Patients in an Integrated Public Health System

The impact of familial involvement on dropout in a culturally informed group therapy for people diagnosed with ‘schizophrenia’

ABSTRACT Background Individuals with schizophrenia diagnoses are high-risk for dropout from mental health treatments, yet few studies have examined whether familial involvement in therapy impacts dropout. Methods We examined whether familial involvement and other demographic variables predicted dropout among 101 patients enrolled in culturally informed group therapy for people diagnosed with ‘schizophrenia’ (CIGT-S), which incorporates collectivistic principles and spiritual coping into treatment. We reviewed records and conducted follow-up calls to identify reasons for dropout, and performed survival analyses to identify when dropout was likely. Results Familial involvement was linked to greater engagement with treatment and lower dropout, signifying a mechanism for improving treatment attendance in this group. Ethnic minorities and patients with higher symptom severity demonstrated higher rates of dropout. Most patients dropped out of CIGT-S before treatment began. However, significantly lower levels of dropout were observed among those who made it to session 9 (end of the spirituality module). An inability to maintain contact with participants was the most cited reason for dropout within records, and structural reasons (e.g. moving away) were commonly cited among participants who were successfully followed-up with. Discussion Future work may identify whether family functioning or the quality of familial relationships may predict familial involvement and, consequently, treatment attendance.

Contributory Factors Influencing Interdisciplinary Pediatric Weight Management Program Attendance for Racially Minoritized Youth.

Childhood obesity is a complex medical condition associated with biopsychosocial complications that requires a multifaceted treatment approach. Historically weight management treatment has been challenging to access for racially minoritized youth. This study evaluated factors influencing treatment attendance for racially minoritized youth in a pediatric weight management program between 2018 and 2021. Medical information from 228 participants was collected, including demographics, insurance type, use of telehealth visits, measures of health-related quality of life (HRQOL), distance from the weight management program, and medical history. Although participants entering the weight management program came from across the state, racially minoritized participants from the Indianapolis area were more likely to attend the program. Racially minoritized participants farther from the program were comparatively underrepresented. Relative to families from majority backgrounds, racially minoritized families had the highest public health insurance rates. Specific physical and mental health comorbidities may further increase risk. Results have important implications for pediatric weight management programs to improve access and treatment opportunities for racially minoritized and underserved populations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10880-022-09899-0.

Factors related to substance use treatment attendance after peer recovery coach intervention in the emergency department

IntroductionBrief intervention with peer recovery coach support has been used to generate referrals to substance use disorder treatment from the emergency department (ED). This retrospective study evaluated factors associated with successful linkage to treatment following brief intervention in the ED. MethodsData were extracted from the electronic health record for patients who were referred to substance use treatment from the ED and for whom follow-up data regarding treatment attendance was available (n=666). We examined associations between demographic and insurance variables, substance use, mental health diagnosis, prior abstinence, and stage of change with successful linkage to substance use treatment after ED referral. ResultsThe sample was majority male (68%), White (62%), and had a mean age of 43 years (SD=12). Medicaid was the most common insurance (49%) followed by employer/private (34%). Multivariable logistic regression determined patients with Medicaid (OR=2.94, 95% CI:2.09-4.13, p=<.001), those who had a documented alcohol use disorder diagnosis (OR=1.59, 95% CI:1.074-2.342, p=.02), and those in the “Action” stage of change (OR=2.33, 95% CI:1.47-3.69, p=<.001) had greater odds of being successfully linked to treatment. ConclusionsThese results identify characteristics of patients available in the health record to determine who is more likely or less likely to attend substance use treatment following ED referral. Given appropriate screening, this information could be used to direct standard care resources to those with high likelihood of treatment attendance and strengthen follow-up interventions with peer recovery coaches for those with lower likelihood of treatment attendance.

Cognitive Enhancement Therapy vs social skills training in schizophrenia: a cluster randomized comparative effectiveness evaluation

BackgroundSchizophrenia and related disorders are highly disabling and create substantial burdens for families, communities, and health care systems. Although pharmacological treatments can often lessen the psychotic symptoms that are a hallmark of schizophrenia, they do not lessen the social and cognitive deficits that create the greatest impediments to community engagement and functional recovery. This study builds on prior research on psychosocial rehabilitation by comparing the effectiveness of two treatments demonstrated as efficacious in improving social and community functioning, Cognitive Enhancement Therapy (CET) and a version of Social Skills Training (HOPES/SST).MethodsThe study uses a randomized cluster design in which a pair of clinicians at community- and hospital-based mental service centers deliver either CET or HOPES to at least one group of 6-8 eligible clients for 12 months. Clinicians are trained and then supervised weekly, with ongoing process measurement of treatment fidelity, attendance, satisfaction, and retention, and use of other services. Measures administered at baseline and at 6 and 12 months while in treatment, and then at 18 and 24 months after treatment include social adjustment, quality of life, social skills, positive and negative symptoms, and neuro- and social cognition. We hypothesize that CET will be associated with greater improvements than SST in both the primary outcome of community functioning and the secondary outcomes of neuro- and social cognition and social skills. Secondarily, we hypothesize that more cognitive impairment at baseline and younger age will predict more benefit from CET compared to HOPES.DiscussionResource shortages endemic in mental health services and exacerbated by the pandemic highlight the importance of identifying the most effective approach to improving social and community functioning. We aim to improve understanding of the impact of two efficacious psychosocial treatments and to improve clinicians’ ability to refer to both treatments the individuals who are most likely to benefit from them. We expect the result to be programmatic improvements that improve the magnitude and durability of gains in community functioning.Trial registrationClinicalTrial.gov NCT04321759, registered March 25, 2020.

Evaluating how treatment adherence influences cognitive remediation outcomes

BackgroundThere is evidence that Cognitive Remediation (CR) is an efficacious approach to reduce cognitive and functioning difficulties in people with schizophrenia. However, there is still a limited understanding of what influences different treatment responses. Treatment adherence has been suggested as one factor but has not been investigated systematically. AimTo investigate how the number of CR sessions completed influences treatment outcomes. MethodThis study used data from six randomised controlled trials comparing CR to a control condition. Instrumental variable analysis was used to evaluate the effect of number of treatment sessions on cognitive and functional outcomes. Logistic regression analysis was conducted to identify significant predictors of session attendance. ResultsA total of 440 participants with schizophrenia spectrum diagnosis were considered. Participants were mostly men (71.6%) and had a mean age of 39.6 (SD 10.69). A higher number of CR sessions led to larger improvements in executive function and processing speed at end of therapy. However, number of sessions did not influence outcomes for working memory and functioning. Younger age and higher levels of negative symptoms at baseline were associated with higher treatment attendance. ConclusionThese findings highlight the importance of treatment adherence and underscore the importance of massed practice, at least for some cognitive outcomes. While it may be complex to assess a single session's contribution to outcome in a dose-response fashion, accessing more sessions seems associated with some cognitive benefits. Observing a relationship to functioning may require longer therapy.

Using Machine Learning to Predict Treatment Adherence in Patients on Medication for Opioid Use Disorder.

Patients receiving medication for opioid use disorder (MOUD) may continue using nonprescribed drugs or have trouble with medication adherence, and it is difficult to predict which patients will continue to do so. In this study, we develop and validate an automated risk-modeling framework to predict opioid abstinence and medication adherence at a patient's next attended appointment and evaluate the predictive performance of machine-learning algorithms versus logistic regression. Urine drug screen and attendance records from 40,005 appointments drawn from 2742 patients at a multilocation office-based MOUD program were used to train logistic regression, logistic ridge regression, and XGBoost models to predict a composite indicator of treatment adherence (opioid-negative and norbuprenorphine-positive urine, no evidence of urine adulteration) at next attended appointment. The XGBoost model had similar accuracy and discriminative ability (accuracy, 88%; area under the receiver operating curve, 0.87) to the two logistic regression models (accuracy, 88%; area under the receiver operating curve, 0.87). The XGBoost model had nearly perfect calibration in independent validation data; the logistic and ridge regression models slightly overestimated adherence likelihood. Historical treatment adherence, attendance rate, and fentanyl-positive urine at current appointment were the strongest contributors to treatment adherence at next attended appointment. There is a need for risk prediction tools to improve delivery of MOUD. This study presents an automated and portable risk-modeling framework to predict treatment adherence at each patient's next attended appointment. The XGBoost algorithm appears to provide similar classification accuracy to logistic regression models; however, XGBoost may offer improved calibration of risk estimates compared with logistic regression.

The Impact of COVID-19 on Dental Treatment in Kuwait-A Retrospective Analysis from the Nation's Largest Hospital.

Background: The COVID-19 pandemic has changed the way dentistry has been practiced the world over. This study sought to assess the impact of the COVID-19 pandemic on the patterns of attendance for dental treatment in a large hospital in Kuwait through comparisons with data from the year prior to the pandemic. Methods: A total of 176,690 appointment records from 34,250 patients presenting to the AlJahra specialist hospital in Kuwait for dental treatment from April 2019 to March 2021 were analyzed. The types of procedures and the departments in which they presented were analyzed, and the patterns of attendance before and during the pandemic were compared. Results: While there was a significant reduction in the number of orthodontic, endodontic, and periodontal procedures, there were no impacts on oral surgery, restorative procedures, or pediatric dentistry. Conclusions: There has been a return in the number of patients obtaining dental treatment; however, there has been a definite shift in the use of certain dental procedures.

Is the combination of behavioral activation and attention training technique effective to reduce depressive symptomatology? A multiple case study.

BackgroundThis study tested whether the combination of BATD and Attention Training Technique (ATT) is effective to reduce depressive symptomatology and investigate the mechanisms of action underlying the effectiveness of treatment with a multiple N-of-1 trials.MethodsNine adults with depressive symptoms were randomly included in three different combinations of BATD and ATT, concurrent in Condition 1 and sequential in Conditions 2 and 3 (ATT followed by BATD and BATD followed by ATT, respectively). The sequential components allow investigating the specific changes that occur during the two distinct treatment phases. Multiple self-report and pre–post-assessments were conducted on generic mental health measures (depressive symptoms, life functioning, mood, and well-being) and intervention-specific measures (behavioral activation, behavioral avoidance, self-focused attention, cognitive control and rumination), with two-week and three-month follow-up assessments. We also measured treatment adherence with treatment attendance, homework compliance and a clinical interview.ResultsParticipants’ attendance, homework compliance and satisfaction were acceptable in the three conditions, with higher adherence in Condition 1 and Condition 3. Eight participants out of nine reported a reduction in depressive symptomatology and five an improvement in well-being. Most of their progress was maintained 2 weeks after the intervention but not 3 months later. Conditions 1 and 2 seemed to be associated with a higher response to generic mental health measures in comparison with Condition 3. The three conditions were not associated with consistent changes in intervention-specific measures, except for rumination with five participants out of nine reporting an improvement in rumination immediately after the intervention and eight participants 2 weeks after the intervention. The concurrent format was associated with a better improvement in rumination immediately after the intervention. No specific changes of self-focused attention and rumination characterized ATT, and no specific changes of behavioral activation, behavioral avoidance and rumination characterized BATD.ConclusionOur three interventions were judged acceptable and showed positive short-term benefit for generic mental health measures and rumination maintained 2 weeks later, but not 3 months later. Results suggest that five sessions of concurrent treatment could be a better option than sequential formats. However, our data did not support the specificity of ATT and BATD treatments.Clinical Trial Registration: This trial was previously registered with the ClinicalTrials.gov NCT04595539 registration number and the title “Does Attention Training Technique Enhance the Effectiveness of Behavioral Activation Treatment for Depression: A Multiple Baseline Study.”

Motivational interviewing to enhance psychosocial treatment attendance in people with SMI

BackgroundWhile there is increasing support for the efficacy of psychosocial interventions for people with SMI, the real-world effectiveness of such treatments is diminished by lack of motivation for treatment, leading to poor treatment engagement/dropout. We sought to evaluate the efficacy of motivational interviewing (MI) in improving attendance in a full course of cognitive training, examine motivation level as a potential mechanism of action, and examine variables associated with initial engagement in the training. MethodsOne hundred fourteen participants with SMI were randomized to MI or sham control interview (CI), both of which were followed by a 4-month active phase during which participants could attend up to 50 unpaid cognitive training sessions. ResultsFidelity to the MI intervention was high, and MI condition was associated with increases in perceived value of training tasks and, to a lesser extent, how enjoyable/interesting they were rated. Twenty-nine percent of the full sample did not attend any training sessions. In ITT analyses, there was no significant between-group impact of MI on treatment attendance, though one emerged when participants who did not attend any sessions were excluded. Treatment attendance was predicted by the level of motivation achieved after the MI/CI intervention. Those who attended at least one training session (regardless of randomization) were more likely to believe they had cognitive impairments, had higher IQ and had less severe general psychiatric symptoms. ConclusionsMI showed some promise and may be a worthwhile addition to more comprehensive, robust efforts to promote initial treatment engagement and subsequent adherence.