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Imai H, Luo Y, Funada S, Hashimoto T, Matsuishi K, Takamatsu T, Yoshihara Y, Hiraoka Y, Mizui Y, Hayasaka Y, Takeshima N, Fukushima H, Matsuda K, Hashimoto T, Furukawa TA. Movie- and mobile-therapy without therapist involvment for patients with obsessive-compulsive disorder: Protocol for a randomized controlled trial. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2025; 4:e70065. [PMID: 39963546 PMCID: PMC11830560 DOI: 10.1002/pcn5.70065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 12/21/2024] [Accepted: 01/26/2025] [Indexed: 02/20/2025]
Abstract
Background Self-help programs without therapist involvement for obsessive-compulsive disorder (OCD) are promising, but the high dropout rate is a significant issue. Our software, which incorporates entertainment elements, showed a completion rate of over 80% in a pre-post comparison study, with superior effectiveness. This is the protocol for a study that aims to evaluate the efficacy and tolerability of a video-based mobile application for OCD treatment through a randomized controlled trial. Methods This study is designed as a randomized controlled trial with two parallel group comparison, with assessors blinded to group allocation. The study will include outpatients aged 18 years or older diagnosed with OCD. The intervention group will receive a mobile-device-based intervention using an application grounded in cognitive behavioral therapy. The treatment period will be 8 weeks, during which 21 sessions will be conducted. Participants not allocated to the intervention group will be assigned to a waitlist control group for 8 weeks. The primary outcome for effectiveness will be the comparison of the Yale-Brown Obsessive Compulsive Scale. As the primary outcome for tolerability, participants in the intervention group who complete 80% or more of the sessions by the 8-week point will be defined as treatment completers, and the proportion of completers will be calculated. Assuming a 10% attrition rate, a total of 88 participants will be needed. Results Results will be presented according to the protocol. Conclusions If this study demonstrates that OCD can be improved through mobile-based self-help treatment without therapist involvement, it will become an important treatment option for patients.
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Affiliation(s)
- Hissei Imai
- Health Promotion and Human BehaviorKyoto University Graduate School of Medicine/School of Public HealthKyotoJapan
- Ohashi Psychiatry ClinicTakarazukaJapan
| | - Yan Luo
- Center for Medical Education and InternationalizationKyoto University Graduate School of MedicineKyotoJapan
| | - Satoshi Funada
- Health Technology Assessment Unit, Department of Preventive Medicine and Public HealthKeio University School of MedicineTokyoJapan
| | | | - Kunitaka Matsuishi
- Department of PsychiatryKobe City Medical Center General HospitalKobeJapan
| | | | | | | | | | - Yu Hayasaka
- Health Promotion and Human BehaviorKyoto University Graduate School of Medicine/School of Public HealthKyotoJapan
- Otaka Psychiatry ClinicNagareyamaJapan
| | - Nozomi Takeshima
- Health Promotion and Human BehaviorKyoto University Graduate School of Medicine/School of Public HealthKyotoJapan
- Tsunagari ClinicFujisawaJapan
| | - Haruko Fukushima
- Department of PsychiatryKobe City Medical Center General HospitalKobeJapan
| | - Kohei Matsuda
- Department of PsychiatryKobe City Medical Center General HospitalKobeJapan
| | - Takashi Hashimoto
- Department of PsychiatryKobe City Medical Center General HospitalKobeJapan
| | - Toshi A. Furukawa
- Office of Institutional Advancement and CommunicationsKyoto UniversityKyotoJapan
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Sica A, McCabe C, Tierney K. An assessment of the association between therapeutic relationships and insight among those with acquired brain injury and intellectual disability. DISCOVER MENTAL HEALTH 2025; 5:24. [PMID: 39998571 PMCID: PMC11861831 DOI: 10.1007/s44192-025-00150-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 02/19/2025] [Indexed: 02/27/2025]
Abstract
The association between therapeutic relationships (TR) and Insight into overall deficit and skill among clinical populations is supported by a very limited number of studies. Even fewer of these have explored the association in brain injury or disability populations, and none have explored the association outside of therapeutic settings with qualified professionals such as psychologists. In fact, the impact of TR on Insight when interventions are delivered by frontline, non-clinically trained staff is virtually unexplored. This explorative, correlational study of 24 adults with acquired brain injury (ABI) (N = 11) and intellectual disability (ID; N = 13) and their 24 keyworkers aimed to address this gap. The Scale To Assess Therapeutic Relationships (STAR) provided the measure of TR while the Patient Competency Rating Scale (PCRS) provided the measure of Insight. Participants were recruited from a residential community service. Spearman's rho correlations between the STAR and PCRS and each of their subscales revealed no significant correlations in the overall sample. However, several post-hoc correlations reached statistical significance within the ABI group. These findings support the hypothesis of an interplay between TR and Insight following ABI. Reasons why this interplay was not found in the overall sample or the ID group are discussed.
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Affiliation(s)
- Andrea Sica
- Talbot Group Residential Disability Services, Co Meath, Ireland.
- Acquired Brain Injury Ireland, 2nd Floor, Block A, Century House, 100 George's Street Upper, Northumberland Hall, Northumberland Avenue, DunLaoghaire, Dublin, A96 VY26, Ireland.
| | - Corinne McCabe
- Talbot Group Residential Disability Services, Co Meath, Ireland
- Acquired Brain Injury Ireland, 2nd Floor, Block A, Century House, 100 George's Street Upper, Northumberland Hall, Northumberland Avenue, DunLaoghaire, Dublin, A96 VY26, Ireland
| | - Kevin Tierney
- Department of Psychology, Trinity College Dublin, Dublin, Ireland
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Nakimuli-Mpungu E, Kwesiga JM, Bwanika JM, Musinguzi D, Nakanyike C, Iya J, Bakeera Kitaka S, Akimana B, Hawkins C, Cavazos P, Nachega JB, Mills EJ, Seggane M. Developing and testing tele-support psychotherapy using mobile phones for depression among youth in Kampala district, Uganda: study protocol for a pilot randomized controlled trial. Front Digit Health 2025; 7:1515193. [PMID: 40041129 PMCID: PMC11876404 DOI: 10.3389/fdgth.2025.1515193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 01/21/2025] [Indexed: 03/06/2025] Open
Abstract
Introduction In the post-COVID-19 era, depressive disorders among youth have risen significantly, creating an urgent need for accessible, cost-effective mental health interventions. This study adapts Group Support Psychotherapy into Tele-Support Psychotherapy (TSP) via mobile phones. It aims to evaluate its feasibility, acceptability, effectiveness, and cost-efficiency in addressing mild to moderate depression among youth in central Uganda. Methods and analysis This study will use a mixed-methods approach, starting with a qualitative phase to adapt Group Support Psychotherapy into Tele-Support Psychotherapy (TSP) via mobile phones. Guided by ecological theories and the Unified Theory of Acceptance and Use of Technology (UTAUT), focus group discussions and interviews with youth, mental health professionals, and stakeholders will inform the development of a youth-tailored call platform integrated into Rocket Health Africa's telehealth services. Data will be analyzed using grounded theory and MAXQDA Analytics Pro 2022 to guide intervention adaptation. An open-label randomized controlled trial will enroll 300 youth (15-30 years) with mild to moderate depression from Kampala, Uganda, to evaluate Tele-Support Psychotherapy (TSP). Participants will be randomized to TSP with standard mental health services (SMHS) or SMHS alone. Primary outcomes include feasibility and acceptability, with secondary outcomes assessing cost-effectiveness, depressive symptom changes, and social support. Intention-to-treat analysis using structural equation modeling will evaluate treatment effects, complemented by qualitative insights into implementation barriers and facilitators. Discussion This study protocol develops and evaluates Tele-Support Psychotherapy (TSP) for youth depression in resource-limited settings, addressing mental health gaps exacerbated by COVID-19. Using user-centered design and mixed methods, it explores TSP's feasibility, adaptability, and cost-effectiveness while addressing barriers like technology literacy, laying the groundwork for accessible digital mental health solutions. Trial Registration PACTR202201684613316.
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Affiliation(s)
- Etheldreda Nakimuli-Mpungu
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
- SEEK Group Support Psychotherapy Initiative, Kampala, Uganda
| | | | | | | | | | - Jane Iya
- SEEK Group Support Psychotherapy Initiative, Kampala, Uganda
| | - Sabrina Bakeera Kitaka
- Department of Pediatrics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Benedict Akimana
- Butabika National Referral Mental Hospital, Ministry of Health of Uganda, Kampala, Uganda
| | | | - Patricia Cavazos
- Health and Behavior Research Center, School of Medicine in St Louis, Washington University, St. Louis, MO, United States
| | - Jean B. Nachega
- Departments of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
- Center for Infectious Disease, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Departments of International Health and Epidemiology, Bloomberg’s School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Edward J. Mills
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Musisi Seggane
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
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Barnett MD, Moore JM, Griffin RA. Development of an Examiner-Examinee Rapport Scale for Neuropsychological Testing: The Barnett Rapport Questionnaire - 2. Assessment 2025:10731911251315626. [PMID: 39927479 DOI: 10.1177/10731911251315626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2025]
Abstract
Rapport in the context of neuropsychological assessment refers to the interpersonal interaction between the examinee and examiner. The purpose of this study was to improve upon the original Barnett Rapport Questionnaire. Participants consisted of college students (n = 55), middle-aged adults (n = 30), and older adults (n = 99) at a university-affiliated neuropsychology clinic, who were administered a brief test battery. After testing, both examinees (n = 184) and examiners (n = 12) completed items regarding the nature of the interpersonal interaction. Confirmatory factor analyses indicated a two-factor model consisting of nine items found on both the examinee and examiner versions. No age cohort differences were found on the total Barnett Rapport Questionnaire - 2 (BRQ-2) scores for the examiner or examinee version; however, older adults endorsed the positively worded items more than young adults, and examiners endorsed the negatively worded items more for young adult examinees than for older adult examinees. No differences were found by gender or by race/ethnicity. The BRQ-2 promises better usability and improved psychometric qualities for the measurement of rapport in the context of neuropsychological assessment.
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Robinson J, Abrams R, Price O, Barley E. Tools used to measure the therapeutic relationship between staff and service users in adult mental health care: A scoping review. Arch Psychiatr Nurs 2025; 54:73-83. [PMID: 39955147 DOI: 10.1016/j.apnu.2025.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 12/12/2024] [Accepted: 01/20/2025] [Indexed: 02/17/2025]
Abstract
BACKGROUND Therapeutic relationships are key to both service user recovery and the safety of staff and service users in adult mental health care. However, staff over-involvement (crossing professional boundaries including sexual and emotional exploitation) and under-involvement (staff disinterest, avoidance or neglect) is often a cause for concern within mental health care. Little is known about measuring and assessing over / under involvement. This scoping review provides a broad understanding of existing tools used to measure this in adult mental health care. OBJECTIVE To explore what measures are used, and the characteristics of the identified measures, to understand the therapeutic relationship between staff and adult service users in mental health care settings. DESIGN Scoping review. SETTING(S) Adult mental health settings. PARTICIPANTS Service users and staff. METHODS This review is guided by Levac et al.'s six stage methodology of scoping review frameworks. The reporting of this review has been guided by the PRISMA-ScR. RESULTS Of 2863 papers found, 23 were eligible for inclusion. The papers identified 14 scales. No tool specifically measured over- or under- involvement. Finally, data indicates that scales should be specific to their intended setting as the nature of therapeutic relationships may vary by setting. CONCLUSIONS Definitions of therapeutic relationships and over- and under-involvement relevant to different settings are needed. There is a need to develop setting-specific scales to measure therapeutic involvement and definitions for over- and under- involvement. This would enhance care provided to service users and encourage staff members to challenge their own boundary setting practices. REGISTRATION https://osf.io/93dxp/.
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Affiliation(s)
- Jade Robinson
- School of Health Sciences, University of Surrey, Surrey, UK.
| | - Ruth Abrams
- School of Health Sciences, University of Surrey, Surrey, UK
| | - Owen Price
- School of Nursing Midwifery and Social Work, University of Manchester, Manchester, UK
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Kidd SA, D'Arcey J, Tackaberry-Giddens L, Asuncion TR, Agrawal S, Chen S, Wang W, McKenzie K, Zhou W, Luo S, Feldcamp L, Kaleis L, Zedan S, Foussias G, Kozloff N, Voineskos A. App for independence: A feasibility randomized controlled trial of a digital health tool for schizophrenia spectrum disorders. Schizophr Res 2025; 275:52-61. [PMID: 39657429 DOI: 10.1016/j.schres.2024.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 09/13/2024] [Accepted: 11/30/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND Given the widespread adoption of smartphone technologies, digital health strategies to address schizophrenia spectrum disorders hold considerable promise. However, there are relatively few trials of digital health interventions for schizophrenia. The App for Independence (A4i) is a multi-function digital platform co-designed by people with schizophrenia, their families, and service providers. HYPOTHESIS This trial was designed to assess the feasibility of A4i. STUDY DESIGN The study was a single-blinded randomized trial. This trial was undertaken to generate feasibility data that might inform the design and utility of future effectiveness and implementation trials. The study took place in Toronto, Canada, with 91 participants randomized to 6 months of A4i use or treatment as usual. Feasibility metrics included recruitment, engagement and retention targets, qualitative and satisfaction data, and a secondary assessment of clinical, quality of life, and treatment adherence outcomes. STUDY RESULTS The COVID-19 pandemic markedly affected the recruitment of both primary participants and clinicians. Feasibility outcomes were difficult to interpret, though they presented some useful information for future trials. Engagement objectives were not achieved. However, A4i-user satisfaction ratings and qualitative feedback were positive, and technology engagement was fairly positive despite implementation challenges. CONCLUSIONS This study adds to emerging discourse regarding how technologies such as A4i are implemented. It suggests that digital technologies are of interest and are received positively by severe mental illness populations, though more work is needed to understand how they are implemented and the optimal methods for researching them.
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Affiliation(s)
- Sean A Kidd
- Centre for Addiction and Mental Health, University of Toronto Department of Psychiatry, Canada.
| | | | | | | | - Sacha Agrawal
- Centre for Addiction and Mental Health, University of Toronto Department of Psychiatry, Canada
| | - Sheng Chen
- Centre for Addiction and Mental Health, University of Toronto Department of Psychiatry, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, University of Toronto Department of Psychiatry, Canada
| | - Kwame McKenzie
- Centre for Addiction and Mental Health, University of Toronto Department of Psychiatry, Canada
| | | | | | | | | | - Saleena Zedan
- University of Toronto Department of Psychology, Canada
| | - George Foussias
- Centre for Addiction and Mental Health, University of Toronto Department of Psychiatry, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, University of Toronto Department of Psychiatry, Canada
| | - Aristotle Voineskos
- Centre for Addiction and Mental Health, University of Toronto Department of Psychiatry, Canada
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Panchalingam J, Horisberger R, Corda C, Kleisner N, Krasnoff J, Burrer A, Spiller T, Edkins V, Seifritz E, Homan P. Motivational Interviewing in Patients with Acute Psychosis: A Feasibility Study. SCHIZOPHRENIA BULLETIN OPEN 2025; 6:sgaf004. [PMID: 40123715 PMCID: PMC11926673 DOI: 10.1093/schizbullopen/sgaf004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/25/2025]
Abstract
Background and Hypothesis Psychotic disorders are among the top causes of disability worldwide. Guidelines emphasize the need for psychotherapeutic approaches in the acute phase of this illness. Motivational interviewing (MI) is highly suitable for establishing a therapeutic alliance wherein the patient's intrinsic motivation can be strengthened to adhere to therapy. This pilot study investigated the feasibility and impact of MI for patients with acute psychosis. Study Design A feasibility study was conducted, comparing MI and supportive counseling. The sample included 20 inpatients, who all received 4 therapy sessions. In line with CONSORT guidelines for pilot and feasibility studies, we measured various feasibility outcomes. Clinical outcomes were assessed using linear regression models, with baseline values used as covariates. Study Results The recruitment target (N = 24) was achieved at 83% in a reasonable timeframe (8 months), with a retention rate of 83% and a completion rate of 71%. The eligibility rate (82 %) was high, the consent rate (48%) was moderate, and both the dropout rate 17% and the missing data rate (0.3%) were low. Regarding the clinical outcomes, a group difference was found for the severity of psychotic symptoms, with an advantage for MI (b = -12.0, 95% CI: [-18.7, -5.2], P < 0.01), although the small sample size must be kept in mind. Conclusions The study demonstrated the feasibility and acceptability of a clinical trial with MI for patients with psychosis in an inpatient setting. MI could offer benefits, particularly in terms of reducing psychotic symptoms.
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Affiliation(s)
- Janani Panchalingam
- Department of Adult Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Rahel Horisberger
- Department of Adult Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Claudio Corda
- Department of Adult Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Nicolas Kleisner
- Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
| | - Julia Krasnoff
- Department of Adult Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Achim Burrer
- Department of Adult Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Tobias Spiller
- Department of Adult Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Victoria Edkins
- Department of Adult Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Erich Seifritz
- Department of Adult Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Philipp Homan
- Department of Adult Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, 8032 Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich & Swiss Federal Institute of Technology Zurich, Zurich, 8057 Zurich, Switzerland
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Labrie NH, Straver P, van Kempen AA, van Veenendaal NR. Communication at work: A survey to explore the relationships between healthcare providers' communication competence and professional quality of life in neonatal care. PEC INNOVATION 2024; 5:100341. [PMID: 39346773 PMCID: PMC11437867 DOI: 10.1016/j.pecinn.2024.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 08/19/2024] [Accepted: 08/31/2024] [Indexed: 10/01/2024]
Abstract
Objective Providing medical care to preterm infants can be rewarding yet also stressful for healthcare providers in the neonatal care unit (NICU). While the impact of provider-parent communication on parent-related stress and satisfaction is widely accepted, little is known about the provider perspective. Therefore, this study explores the relationships between neonatal care providers' communicative competence and their professional quality of life and job satisfaction. Methods Using the NICU Communication Framework, we conducted a cross-sectional survey among N = 300 Dutch pediatricians‑neonatologists, nurses, and ancillary staff. Results Communication performance and providers' job satisfaction were correlated, particularly in terms of perceived quality of care, professional relationships, and personal rewards. When providers deemed communication important and perceived themselves as skilled communicators, job satisfaction increased. Experiencing sufficient time for conversations with parents was inversely correlated with provider fatigue and burn-out. Yet, providers reported insufficient opportunity for communication. Conclusion These results warrant reflection on the importance of communication in neonatal care, for the wellbeing of parents and providers alike. Innovation Focusing on the provider perspective, this study provides novel insights into the relationships between communication and outcomes of care. Our findings uniquely emphasize the power of communication to foster staff satisfaction and reduce burn-out in the NICU.
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Affiliation(s)
- Nanon H.M. Labrie
- Department of Language, Literature & Communication, Vrije Universiteit Amsterdam, the Netherlands
- Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Puck Straver
- Department of Language, Literature & Communication, Vrije Universiteit Amsterdam, the Netherlands
| | | | - Nicole R. van Veenendaal
- Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, the Netherlands
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Labak CM, Mann MJ, Shost MD, Wong M, Herring EZ, Sajatovic M, Hoffer A. Shared Music Experiences During Bedside Neurosurgical Procedures: An ACGME-Sponsored Pilot Study on Fostering Patient-Clinician Alliance Through Music. JOURNAL OF SURGICAL EDUCATION 2024; 81:103224. [PMID: 39369513 DOI: 10.1016/j.jsurg.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/14/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Bedside procedures represent a substantial proportion of the neurosurgical resident's responsibilities. Although music interventions in healthcare have classically been employed for the benefit of the patient, there is evidence in support of its positive effects on healthcare workers as well. OBJECTIVES We aimed to create a novel framework-the shared music experience (SME)-which allows for patient and provider to discuss and mutually select a musical playlist during bedside procedural interventions. METHODS A single-center prospective pilot study with nested design was carried out during a 6-month period. One sample was neurosurgery residents at our institution, while the other was patients undergoing nonemergent bedside procedures. Primary endpoints included change in neurosurgery residents' and patients' perception of patient-provider alliance. Secondary endpoints include quantitative and qualitative analysis of feedback from residents and patients about the SME framework. RESULTS Twelve out of 13 (92.3%) eligible neurosurgery residents were enrolled. Twenty-eight SMEs were carried out. Twenty-six of 28 patients (92.9%) replied that they did enjoy the SME. Patients who partook in SMEs had a significant increase in metrics of patient-clinician alliance as measured by the mARM-5. All 7 residents who participated in at least 1 SME reported having enjoyed performing procedures within the framework and affirmed they would either ''often'' (2/7, 28.6%) or ''always'' (5/7, 71.4%) implement SME in future practice. CONCLUSIONS The SME is a novel intervention that can be employed to help patients and providers find common ground through music and foster the patient-clinician relationship during bedside procedures.
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Affiliation(s)
- Collin M Labak
- University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Michael J Mann
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michael D Shost
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mandy Wong
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Eric Z Herring
- University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Alan Hoffer
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Sawada U, Matsunaga A, Taneda A, Sasaki N, Yamaguchi S. Perspectives of people with schizophrenia on clinical outcome scales and patient-reported outcome measures: a qualitative study. BMC Psychiatry 2024; 24:861. [PMID: 39614162 DOI: 10.1186/s12888-024-06292-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/12/2024] [Indexed: 12/01/2024] Open
Abstract
BACKGROUND Over the past half-century, numerous scales have been designed to quantify outcomes in people with severe mental health disorders. However, little is known about the views of people diagnosed with schizophrenia on individual outcome scales, particularly outside of European countries. AIM We conducted a qualitative study to examine the perspectives of people with schizophrenia on multiple scales in Japan. METHODS Eleven participants took part in focus group interviews. Five had extensive experience as mental health peer supporters; the others had no such experience. To address potential power imbalances and facilitate dynamic discourse, participants were intentionally divided into two groups on the basis of peer support experience, and two simultaneous two-hour focus group interviews were conducted in separate rooms. The participants reviewed 12 clinical and patient-reported outcome measures and discussed their views on each measure. Interview data for each group were combined prior to analysis and qualitatively analyzed by four researchers using a thematic analysis approach. RESULTS The average age of the participants was 42.7 years (SD = 8.3), and six were male. On average, the participants had been living with schizophrenia for 22.2 years (SD = 11.1). After analyzing the interview data, the following five themes were identified, each containing two to seven subthemes: 1) validity and format of the scale construct, 2) factors affecting the accuracy of responses, 3) plain language and familiar words in Japanese culture, 4) psychological impact on the respondents, and 5) containing important items in everyday life. CONCLUSION The participants provided both favorable and unfavorable feedback on each scale. When implementing research utilizing clinical outcome scales and patient-reported outcome measures, researchers should exercise caution considering the potential emotional impact on respondents. Furthermore, scale development should take into account the cultural background and psychological burden experienced by the respondents.
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Affiliation(s)
- Utako Sawada
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Department of Nursing, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya-Shi, Saitama, 343-8540, Japan
| | - Asami Matsunaga
- Department of Mental Health & Psychiatric Nursing, Graduate School of Health Care Sciences, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553, Japan
| | - Ayano Taneda
- Faculty of Health and Social Services, Kanagawa University of Human Services, 1-10-1 Heisei-Cho, Yokosuka, Kanagawa, 238-8522, Japan
| | - Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Sosei Yamaguchi
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8553, Japan.
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Merza D, Amani B, Savoy C, Babiy Z, Bieling PJ, Streiner DL, Ferro MA, Van Lieshout RJ. Online peer-delivered group cognitive-behavioral therapy for postpartum depression: A randomized controlled trial. Acta Psychiatr Scand 2024; 150:422-432. [PMID: 37649448 DOI: 10.1111/acps.13611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/09/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Postpartum depression (PPD) affects up to one in five mothers and birthing parents, yet just 10% receive evidence-based care. This randomized controlled trial aimed to determine if a synchronous online 9-week group cognitive-behavioral therapy (CBT) intervention delivered by mothers who have recovered from postpartum depression (i.e., peers) could effectively improve PPD and its comorbidities. METHODS Participants (n = 183) in this study lived in Ontario, Canada, were ≥18 years-old, had an infant <12 months, were fluent in English, and scored ≥10 on the Edinburgh Postnatal Depression Scale (EPDS). They were randomized to experimental (received intervention plus treatment as usual (TAU)) or waitlist control (TAU plus the intervention after a 9-week wait) groups. Depression, anxiety, social support, mother-infant bonding, and infant temperament were assessed at baseline and 9 weeks later. Outcomes were assessed in the experimental group 3 months post-intervention to assess stability. RESULTS Statistically significant reductions were observed in EPDS (B = 5.99; p < 0.001; d = 1.32) and Generalized Anxiety Disorder Questionnaire-7 scores (B = 5.94; p < 0.001; d = 1.22), improvements that remained stable 3 months post-intervention in the experimental group. Maternal social support (p = 0.02; d = 0.40), infant-focused anxiety (p = 0.02; d = 0.54), and infant negative emotionality (p < 0.01; d = 0.23) also improved post-intervention and remained stable 3 months later. CONCLUSION Online peer-delivered group CBT for PPD can effectively treat PPD and anxiety, and improve social support, infant-focused anxiety, and negative emotionality in infants. This intervention could provide the means to increase access to treatment for those experiencing PPD and improve outcomes for mothers, birthing parents, and families.
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Affiliation(s)
- Donya Merza
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Bahar Amani
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Calan Savoy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Zoryana Babiy
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Peter J Bieling
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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12
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Cruz-Castellanos P, Jiménez-Fonseca P, Galán-Moral R, Piera-Molons N, Gustems M, Calderon C. Expectations concerning cancer treatment: perspectives of medical oncologists and patients on advanced, unresectable lung carcinoma. Front Psychol 2024; 15:1392567. [PMID: 39444838 PMCID: PMC11496176 DOI: 10.3389/fpsyg.2024.1392567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 09/23/2024] [Indexed: 10/25/2024] Open
Abstract
Introduction This study seeks to compare expectations regarding systemic cancer treatment for advanced lung cancer from the perspectives of both patient and medical oncologist. Methods A cross-sectional study involving 17 medical oncologists from 13 Spanish hospitals between 2021 and 2022. Patients with advanced, unresectable lung cancer were recruited prior to initiating systemic cancer treatment. Both patients and oncologists completed the NEOetic-EIT and the STAR. Results Seventeen medical oncologists specializing in lung cancer participated, with a mean age of 36.2 years (range 28-56); 65% were female. The study included 298 patients with advanced, unresectable lung cancer, predominantly non-small cell type (72%), and most at stage IV (77%). Most patients were retired or unemployed (71%), and married or partnered (77%). Treatment approaches varied, with 44% based on biomarkers. Oncologists had greater expectations of positive outcomes for participants with better baseline prognosis, such as ECOG 0, newly diagnosed, locally advanced, unresectable non-small cell lung cancer, and those receiving biomarker-based treatments. In contrast, patients' treatment expectations did not vary based on sociodemographic or clinical factors. Generally, patients had high expectations of cure, in contrast to oncologists' lower expectations, though both anticipated similar quality-of-life improvements. Patients anticipated more side effects than oncologists. Among oncologists, expectations varied by gender and decreased with age and experience, with no differences detected among patients based on gender, age, or doctor-patient relationship. Conclusion This study reveals the complex expectations of patients and oncologists in advanced lung cancer treatment. It underscores the need for effective communication in oncology to align patient expectations with clinical realities.
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Affiliation(s)
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rocío Galán-Moral
- Department of Medical Oncology, Hospital General Ciudad Real, Ciudad Real, Spain
| | - Nuria Piera-Molons
- Department of Medical Oncology, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Marina Gustems
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
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McCabe C, Sica A, Fortune DG. Awareness through relationships in individuals undergoing rehabilitation following acquired brain injury. Neuropsychol Rehabil 2024; 34:1005-1033. [PMID: 37903181 DOI: 10.1080/09602011.2023.2273578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/04/2023] [Indexed: 11/01/2023]
Abstract
AIM This cross-sectional study investigated the association between self-awareness and quality of therapeutic relationships following acquired brain injury (ABI) while controlling for the potential impact of cognitive problems. It also aimed to investigate attachment as a potential moderator. METHOD 83 adults with ABI were recruited alongside a key member of their community neurorehabilitation team. The Scale to Assess Therapeutic Relationships (STAR) was used to measure therapeutic relationship quality and attachment was measured using the Experiences in Close Relationships - Relationship Structure (ECR-RS) questionnaire. Awareness was measured using the Patient Competency Rating Scale (PCRS) and the Mayo-Portland Adaptability Inventory (MPAI-4) provided a measure of cognitive problems. The MPAI-4 also provided an additional measure of awareness. RESULTS A significant association between self-awareness and therapeutic relationships was found in some regression models such that higher-quality relationships were associated with better awareness, after controlling for the impact of cognitive problems. Neither childhood parental attachment nor participants' attachment towards their rehabilitation staff were moderators. CONCLUSION The observed associations between awareness in clients and therapeutic relationships with rehabilitation staff may have importance for rehabilitation in this context. Results highlight the value of continuing to prioritize the therapeutic relational environment in ABI rehabilitation and research.
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Affiliation(s)
- Corinne McCabe
- Department of Psychology, University of Limerick, Co Limerick, Ireland
| | - Andrea Sica
- Acquired Brain Injury Ireland, Co Dublin, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Co Limerick, Ireland
- HSE CHO 3 Mid West, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Magill M, Martino S, Wampold BE. Defining the therapeutic relationship in the context of alcohol use, other drug use, and behavior change: Principles and practices. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209398. [PMID: 38754554 PMCID: PMC11180559 DOI: 10.1016/j.josat.2024.209398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/21/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
OVERVIEW This article contributes to knowledge and practice of core processes that are shared by evidence-based alcohol or other drug (AOD) therapies. It is the fourth in a series with this aim, and here we discuss perhaps the most universally acknowledged ingredient of effective therapy - the therapeutic relationship. We consider various related terms and definitions in the literature, but in the present review, we offer a definition that underscores the context of behavior change. METHOD This study conducted a literature review and qualitative content analysis to derive a set of principles and practices for facilitating and maintaining the therapeutic relationship. The sources for this review included government-issued practice guidelines, therapy manuals or books, demonstration videos, and peer-reviewed articles (61 sources). The content analysis was performed in NVIVO, and reliability analysis showed moderate agreement between raters (kappa = 0.60). RESULTS Six principles and 16 practices were identified. The distribution of principles and practices could be broken into three categories: 1) the facilitation of client behavior change mechanisms (i.e., self-determination, motivation, self-efficacy), 2) partnership considerations (e.g., goal and task alignment), and 3) therapist interpersonal skills (e.g., empathy). CONCLUSIONS The therapeutic relationship is foundational to the behavior change process. We frame it as a combination of broader interpersonal considerations and attention to key mechanisms of client behavior change. The present work provides a novel resource for trainees, clinicians, and clinical supervisors interested in fostering therapy relationships with clients in AOD or other behavior change settings.
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Affiliation(s)
- Molly Magill
- Brown University, Providence, RI, United States of America.
| | - Steve Martino
- Yale University, New Haven, CT, United States of America
| | - Bruce E Wampold
- University of Wisconsin, Madison, WI, United States of America
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15
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Saxler E, Schindler T, Philipsen A, Schulze M, Lux S. Therapeutic alliance in individual adult psychotherapy: a systematic review of conceptualizations and measures for face-to-face- and online-psychotherapy. Front Psychol 2024; 15:1293851. [PMID: 38993343 PMCID: PMC11238262 DOI: 10.3389/fpsyg.2024.1293851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/17/2024] [Indexed: 07/13/2024] Open
Abstract
Background The therapeutic alliance (TA) is a robust and pantheoretical predictor of treatment outcome in Face-to-Face- (F2F-) and Online-psychotherapy (Online-PT). Many authors have proposed several conceptualizations of TA, which are oftentimes operationalized. The resulting diversity of conceptualizations and measures is presented in this review. Methods We performed a three-parted literature search for self-report-instruments of TA in individual, voluntary F2F-PT with adults (1. utilization of past reviews, 2. systematic literature search yielding 5,205 articles, 3. reference lists). Analogously, we conducted a systematic literature search for instruments of TA in the Online-setting (yielding 200 articles). Additionally, we analyzed the content of the instruments qualitatively. Results A current overview of 48 instruments for measuring TA (46 for F2F-PT, 2 for Online-PT) including their conceptual backgrounds, characteristics and main content aspects is presented. Most instruments (n = 24) operationalize one or more theoretical conceptualizations of TA. Other instruments are adaptation/syntheses of existing measures (n = 14), based on literature searches (n = 3) or on an empirical survey (n = 3) and two instruments provide no conceptual background information. The content of the instruments mainly focused on the following aspects: 1. Self-disclosure and authenticity; 2. Agreement; 3. Active participation, motivation and compliance; 4. Trust and secure attachment; and 5. Considering needs/abilities/wishes of the patient. Additionally, a narrative review of various approaches to conceptualize TA is presented and linked to respective corresponding instruments. Discussion The broad variety of conceptualizations and measures of TA makes coherent research on TA difficult. There are conceptual challenges such as the role of attachment style in TA that remain to be clarified. The current conceptualizations and measures do not incorporate the practical experience and expertise of psychotherapists and patients sufficiently. A metatheoretical conceptualization and measure of TA based on an empirical survey of psychotherapists and patients could address these issues.
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Affiliation(s)
- Eva Saxler
- Deutsches Zentrum für Neurodegnerative Erkrankungen, University Clinic of Bonn, Bonn, Germany
| | - Theresa Schindler
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
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16
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De-María B, Topa G, López-González MA. Cultural Competence Interventions in European Healthcare: A Scoping Review. Healthcare (Basel) 2024; 12:1040. [PMID: 38786450 PMCID: PMC11120989 DOI: 10.3390/healthcare12101040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Europe is undergoing rapid social change and is distinguished by its cultural superdiversity. Healthcare is facing an increasing need for professionals to adapt to this environment. Thus, the promotion of cultural competence in healthcare has become a priority. However, the training being developed and their suitability for the European context are not well known. The aim of this qualitative study has been to map the scientific literature in order to comprehend the current state of research on this topic. For this purpose, we conducted a systematic scoping review of the empirical publications focused on cultural competence interventions for healthcare professionals in European countries. The search was conducted in eight thematic (PsycINFO, MedLine, and PubPsych) and multidisciplinary databases (Academic Search Ultimate, E-Journals, Scopus, ProQuest, and Web of Science) to identify relevant publications up to 2023. Results were presented qualitatively. Out of the initial 6506 records screened, a total of 63 publications were included. Although the interventions were implemented in 23 different European countries, cultural competence interventions have not been widely adopted in Europe. Significant heterogeneity was observed in the conception and operacionalización of cultural competence models and in the implementation of the interventions. The interventions have mostly aimed at improving healthcare for minority population groups and have focused on the racial and ethnic dimensions of the individual. Future research is needed to contribute to the conceptual development of cultural competence to design programs tailored to European superdiversity. This scoping review has been registered in OSF and is available for consultation.
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Affiliation(s)
- Berta De-María
- Department of Social and Organizational Psychology, Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain; (B.D.-M.); (G.T.)
| | - Gabriela Topa
- Department of Social and Organizational Psychology, Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain; (B.D.-M.); (G.T.)
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Wolff M, Evens R, Mertens LJ, Schmidt C, Beck J, Rutrecht H, Cherniak AD, Gründer G, Jungaberle H. Measuring psychotherapeutic processes in the context of psychedelic experiences: Validation of the General Change Mechanisms Questionnaire (GCMQ). J Psychopharmacol 2024; 38:432-457. [PMID: 38742761 PMCID: PMC11102652 DOI: 10.1177/02698811241249698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Therapeutic and salutogenic effects of psychedelic drugs have been attributed to psychotherapeutic or psychotherapy-like processes that can unfold during the acute psychedelic experience and beyond. Currently, there are no psychometric instruments available to comprehensively assess psychotherapeutic processes (as conceptualized by empirical psychotherapy research) in the context of psychedelic experiences. AIMS We report the initial validation of the General Change Mechanisms Questionnaire (GCMQ), a self-report instrument designed to measure five empirically established general change mechanisms (GCMs) of psychotherapy-(1) resource activation, (2) therapeutic relationship, (3) problem actuation, (4) clarification, and (5) mastery-in the context of psychedelic experiences. METHODS An online survey in a sample of 1153 English-speaking and 714 German-speaking psychedelic users was conducted to evaluate simultaneously developed English- and German-language versions of the GCMQ. RESULTS The theory-based factor structure was confirmed. The five GCMQ scales showed good internal consistency. Evidence for convergent validity with external measures was obtained. Significant associations with different settings and with therapeutic, hedonic, and escapist use motives confirmed the hypothesized context dependence of GCM-related psychedelic experiences. Indicating potential therapeutic effects, the association between cumulative stressful life events and well-being was significantly moderated by resource activation, clarification, and mastery. Factor mixture modeling revealed five distinct profiles of GCM-related psychedelic experiences. CONCLUSION Initial testing indicates that the GCMQ is a valid and reliable instrument that can be used in future clinical and nonclinical psychedelic research. The five identified profiles of GCM-related experiences may be relevant to clinical uses of psychedelics and psychedelic harm reduction.
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Affiliation(s)
- Max Wolff
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- MIND Foundation, Berlin, Germany
| | - Ricarda Evens
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lea J Mertens
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Jessica Beck
- MIND Foundation, Berlin, Germany
- Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | | | - Aaron D Cherniak
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Psychology, Reichman University, Herzliya, Israel
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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18
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Marchi M, Venturi G, Visentini C, Pinelli M, Priebe S, Galeazzi GM. The therapeutic relationship in community mental health services: a systematic review of the literature. Soc Psychiatry Psychiatr Epidemiol 2024; 59:731-743. [PMID: 37875610 DOI: 10.1007/s00127-023-02581-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE This systematic review aimed to investigate the therapeutic relationship (TR) between mental health professionals (MHPs) and their patients in community mental health services (CMHS). METHODS PubMed (Medline), PsycINFO, CINAHL, CENTRAL, and Web of Science were searched for studies that assessed TR in CMHS using quantitative measures developed specifically for this setting (i.e., Helping Alliance Scale [HAS] and the Scale to Assess the Therapeutic Relationship [STAR]). Studies were included if they considered adult patients with a psychiatric disorder and/or any MHP working in CMHS. Meta-analysis and narrative synthesis assessed the association between patients' and MHPs' ratings and identified predictors of TR. RESULTS Of 1934 studies, 15 were included in the review, including 3004 patients. A total of 1127 patients and 963 MHPs were considered in the meta-analysis. The heterogeneity of the studies was high, and there was no significant difference between the patients' and MHPs' TR ratings in the random-effects model (standardized mean difference [SMD]: - 0.39 [95% CI: - 1.03; 0.24]). In the multivariable meta-regression, only duration of illness was significantly associated with TR ratings (unstandardized regression coefficient [B]: 0.388 [95% CI: 0.217; 0.558]). A recovery-oriented service, shared decision-making, and the recognition of patient needs contributed to more positive TR ratings. CONCLUSION Patients and MHPs converged in their TR ratings, although patients gave lower ratings. Routine assessment of TR in CMHS can inform reflective practice and service development, as TR can be assessed easily and early in the treatment process. Future research should focus on developing and testing interventions to improve TR in CMHS.
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Affiliation(s)
- Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy
| | - Giulia Venturi
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy
| | - Chiara Visentini
- Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Margherita Pinelli
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy
| | | | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy.
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McCabe C, Sica A, Doody N, Fortune DG. Self-awareness and quality of relationships after acquired brain injury: Systematic review without meta-analysis (SWiM). Neuropsychol Rehabil 2024; 34:335-361. [PMID: 36908086 DOI: 10.1080/09602011.2023.2186437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Relational aspects of self-awareness following Acquired Brain Injury (ABI) are increasingly being recognized. However, research underpinning the nature of the association between self-awareness and quality of relationships has yet to be synthesized. METHOD Searches, which were completed between February 2022 and February 2023, consisted of combining terms related to ABI, self-awareness, and quality of relationships. Data were analyzed using the Synthesis Without Meta-Analysis (SWiM) approach. RESULTS Associations between self-awareness and relationship quality across eight studies identified for this review differed in direction and significance. A more consistent pattern emerged, however, when studies assessing the quality of specific types of relationships i.e., spousal (N = 1) and therapeutic (N = 3), were compared to studies assessing the quality of a person's broader network of relationships (N = 4). In particular, good awareness was positively associated with the quality of specific relationships (r = 0.66) whereas it was negatively associated with the quality of a person's broader network of relationships (r = -0.35). CONCLUSION Results are discussed with consideration given to measures assessing the quality of specific relationships. In particular, such measures may tap into important patterns of interaction between two individuals, such as those related to attunement or communication, which may be valuable preconditions for improving awareness.
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Affiliation(s)
- Corinne McCabe
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
| | - Andrea Sica
- Acquired Brain Injury Ireland, Dublin, Ireland
| | - Niamh Doody
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
- HSE CHO 3 Mid West, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Kaye S, Hood S, Cragun D, Perry DF, Campos PC, Ajisope O, Schoch AD. Maintaining Family Engagement During Home Visitor Turnover: a Mixed Methods Study of Best Practices. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:470-480. [PMID: 38563858 PMCID: PMC11093809 DOI: 10.1007/s11121-024-01669-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
Evidence-based home visiting services (EBHV) are available in states and localities nationwide through the federally-funded Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Nevertheless, the anticipated benefits of EBHV, such as improved child developmental outcomes and increased positive parenting practices, may be undermined by the fact that most families withdraw from services earlier than the model developers planned. Prior studies have linked family attrition with staff turnover. The current study used a mixed methods design to investigate the conditions under which families remained active in the home visiting program after their assigned home visitor resigned. Coincidence Analysis revealed that giving families advance notice (at least 1 month) prior to the home visitors' upcoming resignation or developing a strong positive working alliance with the inheriting home visitor appears to independently make a difference for ongoing family engagement at 3 and 6 months following a staff transition. These findings suggest that emphasizing how staff turnover is managed may mitigate the risk of family withdrawal during these transitions.
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Affiliation(s)
- Sarah Kaye
- Kaye Implementation and Evaluation, Tacoma, USA
| | | | - Deborah Cragun
- University of South Florida College of Public Health, Tampa, USA
| | - Deborah F Perry
- Center for Child and Human Development, Georgetown University, 2115 Wisconsin Ave NW, Washington, DC, USA.
| | - Paula Cortés Campos
- Center for Child and Human Development, Georgetown University, 2115 Wisconsin Ave NW, Washington, DC, USA
| | - Oluwatosin Ajisope
- Center for Child and Human Development, Georgetown University, 2115 Wisconsin Ave NW, Washington, DC, USA
| | - Annie Davis Schoch
- Center for Child and Human Development, Georgetown University, 2115 Wisconsin Ave NW, Washington, DC, USA
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Thongsalab J, Yunibhand J, Uthis P. Navigating personal recovery: multinomial logistic regression analysis of schizophrenia outcomes in community-dwelling individuals. Gen Psychiatr 2024; 37:e101325. [PMID: 38510927 PMCID: PMC10952847 DOI: 10.1136/gpsych-2023-101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/31/2024] [Indexed: 03/22/2024] Open
Abstract
Background Schizophrenia is a chronic mental disorder affecting individuals globally, emphasising the significance of personal recovery in mental healthcare. Understanding the recovery stages and the associated factors can provide essential insights for targeted interventions. Aims This study aimed to discern the stages of personal recovery in Thai patients with schizophrenia and elucidate the associated factors with each stage. Methods A multistage sampling technique was employed, selecting 231 patients with schizophrenia from mental health outpatient departments of general and psychiatric hospitals. Data collected from March to May 2023 included screening for psychotic symptoms using the Brief Psychiatric Rating Scale and six self-report questionnaires-Stage of Recovery Scale, Beck Cognitive Insight Scale, Brief Resilience Scale, Family Support, Therapeutic Relationship-Patients Version and Social Support Questionnaire-along with personal data sheets. Pearson correlation and multinomial logistic regression were performed. Results The predominant personal recovery stage among participants was stage 3, 'living with disabilities', comprising 42.4% of the participants. Key factors contributing to personal recovery, explaining approximately 38.4% of the variance, included resilience, family support, therapeutic alliance, hospitalisations since onset and recovery-oriented nursing service utilisation. Logit equations for stages 3 and 4 are as follows: stage 3 (living with disability): logit=-4.44+0.74×resilience+0.07×therapeutic alliance+0.02×recovery-oriented nursing service utilisation; stage 4 (living beyond disability): logit=-11.57-0.05×hospitalisation since onset+1.96×resilience+0.11×family support+0.06×therapeutic alliance. Conclusion The findings emphasise the significance of mental health nursing interventions. In conjunction with recovery-oriented nursing services, strengthening resilience, therapeutic alliances and family support may accelerate personal recovery and reduce hospitalisations among individuals with schizophrenia.
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Affiliation(s)
| | | | - Penpaktr Uthis
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
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D'Arcey JN, Zhao H, Wang W, Voineskos AN, Kozloff N, Kidd SA, Foussias G. An SMS text messaging intervention to improve clinical engagement in early psychosis: A pilot randomized-controlled trial. Schizophr Res 2024; 264:416-423. [PMID: 38241785 DOI: 10.1016/j.schres.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 12/19/2023] [Accepted: 01/01/2024] [Indexed: 01/21/2024]
Abstract
Disengagement of youth with psychosis from Early Psychosis Intervention (EPI) services continues to be a significant barrier to recovery, with approximately one-third prematurely discontinuing treatment despite the ongoing need. The current pilot trial sought to evaluate the preliminary efficacy and feasibility of a weekly short message service (SMS) intervention to improve engagement in EPI services. This was a longitudinal single-blinded randomized control trial in which participants were assigned to receive either an active or sham SMS intervention over nine months. Sixty-one participants with early psychosis between the ages of 16 and 29 were enrolled, randomized, and received at least part of the intervention. Primary outcomes consisted of participant clinic attendance rates over the course of the intervention and clinician-rated engagement. Secondary measures included patient-rated therapeutic rapport, attitude toward medication, psychopathology, cognition, functioning, and intervention feedback from participants. Compared to the sham group, participants receiving the active intervention did not show improved appointment attendance rates; however, did exhibit some improvements in aspects of engagement, including improved clinician-rated availability, attitude toward medication, positive symptoms, avolition-apathy and social functioning. Thus, contrary to our hypotheses, digitally augmented care did not result in enhanced engagement in EPI services, as measured by clinic attendance, although with some indication that it may contribute to improved attitude toward medication and, potentially, medication adherence. Weekly SMS text messaging appeared to result in a pattern of engagement whereby individuals who were improving clinically attended appointments less often, possibly due to inadvertent use of the intervention to check in with clinicians. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04379349).
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Affiliation(s)
- Jessica N D'Arcey
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada
| | - Haoyu Zhao
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada
| | - Wei Wang
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada; College of Public Health, University of South Florida, United States of America
| | - Aristotle N Voineskos
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada; Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Sean A Kidd
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - George Foussias
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada; Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada.
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Pinto da Costa M, Virdi K, Kouroupa A. A Phone Pal to overcome social isolation in patients with psychosis-Findings from a feasibility trial. PLOS DIGITAL HEALTH 2024; 3:e0000410. [PMID: 38215157 PMCID: PMC10786382 DOI: 10.1371/journal.pdig.0000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/13/2023] [Indexed: 01/14/2024]
Abstract
People with psychosis often experience social isolation due to stigma. Several volunteering programmes that exist in the community to support patients expect in-person meetings, requiring greater availability and commitment. This study investigated the acceptability and feasibility of remote volunteering over a smartphone for people with psychosis over 12 weeks, exploring its potential impact on both patients and volunteers. A total of 36 participants took part in the study. In the first phase, six participants were recruited in less than three weeks in London. All established contact with their match, and there were no study withdrawals. In the second phase, 30 additional participants were recruited in four weeks, across the United Kingdom. Most patients and volunteers reported that they primarily used audio calls to make contact, followed by text messages, WhatsApp messages and video calls. There were improvements in patients' scores of quality of life, self-esteem, social contacts and symptoms, and in volunteers' ratings of quality of life, physical activity, self-esteem, social comparison, and social distance towards people with mental illness. This study demonstrates that it is feasible, acceptable and safe to remotely connect volunteers and people with psychosis who are afar. Trial registration: ISRCTN17586238 (registration date: 28/09/2018).
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Affiliation(s)
- Mariana Pinto da Costa
- King’s College London, London, United Kingdom
- Queen Mary University of London, London, United Kingdom
| | - Kirat Virdi
- Essex Partnership NHS Foundation Trust, Essex, United Kingdom
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Carmona-Bayonas A, Rodriguez-Gonzalez A, García-García T, Velasco-Durantez V, Hernández-San Gil R, Cruz-Castellanos P, Fernandez-Montes A, Castillo-Trujillo A, Ballester I, Rogado J, Calderon C, Jimenez-Fonseca P. Can Oncologists Prompt Patient Prognostic Awareness to Enhance Decision-Making? Data From the NEOetic Study. Oncologist 2023; 28:986-995. [PMID: 37185783 PMCID: PMC10628594 DOI: 10.1093/oncolo/oyad100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/21/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Anti-neoplastic therapy improves the prognosis for advanced cancer, albeit it is not curative. An ethical dilemma that often arises during patients' first appointment with the oncologist is to give them only the prognostic information they can tolerate, even at the cost of compromising preference-based decision-making, versus giving them full information to force prompt prognostic awareness, at the risk of causing psychological harm. METHODS We recruited 550 participants with advanced cancer. After the appointment, patients and clinicians completed several questionnaires about preferences, expectations, prognostic awareness, hope, psychological symptoms, and other treatment-related aspects. The aim was to characterize the prevalence, explanatory factors, and consequences of inaccurate prognostic awareness and interest in therapy. RESULTS Inaccurate prognostic awareness affected 74%, conditioned by the administration of vague information without alluding to death (odds ratio [OR] 2.54; 95% CI, 1.47-4.37, adjusted P = .006). A full 68% agreed to low-efficacy therapies. Ethical and psychological factors oriented first-line decision-making, in a trade-off in which some lose quality of life and mood, for others to gain autonomy. Imprecise prognostic awareness was associated with greater interest in low-efficacy treatments (OR 2.27; 95% CI, 1.31-3.84; adjusted P = .017), whereas realistic understanding increased anxiety (OR 1.63; 95% CI, 1.01-2.65; adjusted P = 0.038), depression (OR 1.96; 95% CI, 1.23-3.11; adjusted P = .020), and diminished quality of life (OR 0.47; 95% CI, 0.29-0.75; adjusted P = .011). CONCLUSION In the age of immunotherapy and targeted therapies, many appear not to understand that antineoplastic therapy is not curative. Within the mix of inputs that comprise inaccurate prognostic awareness, many psychosocial factors are as relevant as the physicians' disclosure of information. Thus, the desire for better decision-making can actually harm the patient.
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Affiliation(s)
- Alberto Carmona-Bayonas
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, UMU, IMIB, Murcia, Spain
| | - Adán Rodriguez-Gonzalez
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Teresa García-García
- Department of Medical Oncology, Hospital General Universitario Santa Lucia, Cartagena, Spain
| | - Verónica Velasco-Durantez
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Oviedo, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | | | | | - Ana Fernandez-Montes
- Department of Medical Oncology, Complejo Hospitalario Universitario de Ourense, Orense, Spain
| | - Alfredo Castillo-Trujillo
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Inmaculada Ballester
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, UMU, IMIB, Murcia, Spain
| | - Jacobo Rogado
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology. University of Barcelona, Spain
| | - Paula Jimenez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Faculty of Medicine, University of Oviedo, Oviedo, Spain
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Donoghue K, Boniface S, Brobbin E, Byford S, Coleman R, Coulton S, Day E, Dhital R, Farid A, Hermann L, Jordan A, Kimergård A, Koutsou ML, Lingford-Hughes A, Marsden J, Neale J, O'Neill A, Phillips T, Shearer J, Sinclair J, Smith J, Strang J, Weinman J, Whittlesea C, Widyaratna K, Drummond C. Adjunctive Medication Management and Contingency Management to enhance adherence to acamprosate for alcohol dependence: the ADAM trial RCT. Health Technol Assess 2023; 27:1-88. [PMID: 37924307 PMCID: PMC10641712 DOI: 10.3310/dqkl6124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
Background Acamprosate is an effective and cost-effective medication for alcohol relapse prevention but poor adherence can limit its full benefit. Effective interventions to support adherence to acamprosate are therefore needed. Objectives To determine the effectiveness of Medication Management, with and without Contingency Management, compared to Standard Support alone in enhancing adherence to acamprosate and the impact of adherence to acamprosate on abstinence and reduced alcohol consumption. Design Multicentre, three-arm, parallel-group, randomised controlled clinical trial. Setting Specialist alcohol treatment services in five regions of England (South East London, Central and North West London, Wessex, Yorkshire and Humber and West Midlands). Participants Adults (aged 18 years or more), an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis of alcohol dependence, abstinent from alcohol at baseline assessment, in receipt of a prescription for acamprosate. Interventions (1) Standard Support, (2) Standard Support with adjunctive Medication Management provided by pharmacists via a clinical contact centre (12 sessions over 6 months), (3) Standard Support with adjunctive Medication Management plus Contingency Management that consisted of vouchers (up to £120) to reinforce participation in Medication Management. Consenting participants were randomised in a 2 : 1 : 1 ratio to one of the three groups using a stratified random permuted block method using a remote system. Participants and researchers were not blind to treatment allocation. Main outcome measures Primary outcome: self-reported percentage of medication taken in the previous 28 days at 6 months post randomisation. Economic outcome: EuroQol-5 Dimensions, a five-level version, used to calculate quality-adjusted life-years, with costs estimated using the Adult Service Use Schedule. Results Of the 1459 potential participants approached, 1019 (70%) were assessed and 739 (73 consented to participate in the study, 372 (50%) were allocated to Standard Support, 182 (25%) to Standard Support with Medication Management and 185 (25%) to Standard Support and Medication Management with Contingency Management. Data were available for 518 (70%) of participants at 6-month follow-up, 255 (68.5%) allocated to Standard Support, 122 (67.0%) to Standard Support and Medication Management and 141 (76.2%) to Standard Support and Medication Management with Contingency Management. The mean difference of per cent adherence to acamprosate was higher for those who received Standard Support and Medication Management with Contingency Management (10.6%, 95% confidence interval 19.6% to 1.6%) compared to Standard Support alone, at the primary end point (6-month follow-up). There was no significant difference in per cent days adherent when comparing Standard Support and Medication Management with Standard Support alone 3.1% (95% confidence interval 12.8% to -6.5%) or comparing Standard Support and Medication Management with Standard Support and Medication Management with Contingency Management 7.9% (95% confidence interval 18.7% to -2.8%). The primary economic analysis at 6 months found that Standard Support and Medication Management with Contingency Management was cost-effective compared to Standard Support alone, achieving small gains in quality-adjusted life-years at a lower cost per participant. Cost-effectiveness was not observed for adjunctive Medication Management compared to Standard Support alone. There were no serious adverse events related to the trial interventions reported. Limitations The trial's primary outcome measure changed substantially due to data collection difficulties and therefore relied on a measure of self-reported adherence. A lower than anticipated follow-up rate at 12 months may have lowered the statistical power to detect differences in the secondary analyses, although the primary analysis was not impacted. Conclusions Medication Management enhanced with Contingency Management is beneficial to patients for supporting them to take acamprosate. Future work Given our findings in relation to Contingency Management enhancing Medication Management adherence, future trials should be developed to explore its effectiveness and cost-effectiveness with other alcohol interventions where there is evidence of poor adherence. Trial registration This trial is registered as ISRCTN17083622 https://doi.org/10.1186/ISRCTN17083622. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 22. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kim Donoghue
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Sadie Boniface
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- Institute of Alcohol Studies, London, UK
| | - Eileen Brobbin
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology and Neuroscience, King's Health Economics, King's College London, London UK
| | - Rachel Coleman
- Faculty of Health Sciences, Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Edward Day
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Ranjita Dhital
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- Arts and Sciences Department, University College London, London, UK
| | - Anum Farid
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- What Works for Children's Social Care, London, UK
| | - Laura Hermann
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- Faculty of Health Sciences, Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK
| | - Amy Jordan
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- Black Country Healthcare NHS Foundation Trust, West Bromwich, UK
| | - Andreas Kimergård
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | | | - Anne Lingford-Hughes
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - John Marsden
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Joanne Neale
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Aimee O'Neill
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Thomas Phillips
- Faculty of Health Sciences, Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK
| | - James Shearer
- Institute of Psychiatry, Psychology and Neuroscience, King's Health Economics, King's College London, London UK
| | - Julia Sinclair
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Joanna Smith
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - John Strang
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Cate Whittlesea
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Kideshini Widyaratna
- Institute of Psychiatry Psychology and Neuroscience, Department of Psychology, King's College London, London, UK
| | - Colin Drummond
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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26
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Patterson C, Roberts M, Perlman D, Moxham L. The Role of Self-Determined Motivation and the Potential for Pre-registration Student Learning: A Comparative Study within a Mental Health Clinical Placement. Issues Ment Health Nurs 2023:1-6. [PMID: 37418704 DOI: 10.1080/01612840.2023.2222829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
Developing therapeutic relationship skills as well as clinical skill confidence is critical for nursing students. While the nursing literature has examined multiple factors that influence student learning, little is known about the role of student motivation in skill development in non-traditional placement settings. Although therapeutic skills and clinical confidence are vital across a variety of contexts, here we focus on its development in mental health settings. The present study aimed to investigate whether the motivational profiles of nursing students varied with the learning associated with developing (1) a therapeutic relationship in mental health and (2) mental health clinical confidence. We examined students' self-determined motivation and skill development within an immersive, work-integrated learning experience. Undergraduate nursing students (n = 279) engaged in five-day mental health clinical placement, "Recovery Camp," as part of their studies. Data were collected via the Work Task Motivation Scale, Therapeutic Relationship Scale and the Mental Health Clinical Confidence Scale. Students were ranked into either high (top-third), moderate (mid-third) or low (bottom-third) motivation-level groups. These groups were compared for differences in Therapeutic Relationship and Mental Health Clinical Confidence scores. Students higher in motivation reported significantly higher therapeutic relationship skills (Positive Collaboration, p < .001; Emotional Difficulties, p < .01). Increased student motivation was also associated with greater clinical confidence compared to each lower-ranked motivation group (p ≤ .05). Our findings show that student motivation plays a meaningful role in pre-registration learning. Non-traditional learning environments may be uniquely placed to influence student motivation and enhance learning outcomes.
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Affiliation(s)
- Christopher Patterson
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Michelle Roberts
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Dana Perlman
- School of Education, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Lorna Moxham
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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27
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Oluwoye O, Stokes BI, Burduli E, Kriegel LS, Hoagwood KE. Community-based family peer navigator programme to facilitate linkage to coordinated specialty care for early psychosis among Black families in the USA: A protocol for a hybrid type I feasibility study. BMJ Open 2023; 13:e075729. [PMID: 37407058 PMCID: PMC10335551 DOI: 10.1136/bmjopen-2023-075729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Approximately 70% of Black/African American family members report no contact with mental health providers prior to initial diagnosis and the receipt of services for early psychosis. Black families often encounter barriers and experience delays on the pathway to coordinated specialty care programmes for early psychosis. METHODS AND ANALYSIS This mixed-methods study will (1) develop and refine a family peer navigator (FPN) for Black families designed to increase access and engagement in coordinated specialty care and (2) pilot-test FPN for Black families with 40 family members with loved ones at risk for psychosis in a randomised trial to assess the acceptability and feasibility. Families will be randomised to FPN (n=20) or a low-intensive care coordination (n=20). Other outcomes include proposed treatment targets (eg, knowledge, social connectedness), preliminary impact outcomes (time to coordinated specialty care programmes, initial family engagement), and implementation outcomes (acceptability, feasibility, appropriateness). ETHICS AND DISSEMINATION Ethics approval has been obtained from Washington State University Institutional Review Board and informed consent will be obtained from all participants. This study will establish an innovative culturally responsive FPN programme and implementation strategy, and generate preliminary data to support a larger hybrid effectiveness-implementation trial. Study findings will be presented at conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05284721.
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Affiliation(s)
- Oladunni Oluwoye
- Community and Behavioral Health, Washington State University Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Bryony I Stokes
- Community and Behavioral Health, Washington State University Elson S. Floyd College of Medicine, Spokane, Washington, USA
- Department of Human Development, Washington State University, Pullman, Washington, USA
| | - Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Liat S Kriegel
- Community and Behavioral Health, Washington State University Elson S. Floyd College of Medicine, Spokane, Washington, USA
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28
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Nguyen M, Beltramo G, Audia S, Devilliers H, Laurent A, Blot M. [Correlation between Objective structured clinical examinations (OSCE) and knowledge examination scores and analysis of factors associated with better OSCE success in fourth and fifth year medicine students at Dijon university hospital]. Rev Med Interne 2023:S0248-8663(23)00114-5. [PMID: 37024357 DOI: 10.1016/j.revmed.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/08/2023] [Accepted: 03/17/2023] [Indexed: 04/08/2023]
Abstract
RATIONALE Objective structured clinical examinations (OSCEs) were introduced to evaluate students not only on their knowledge, but also on their clinical skills and attitudes. The objectives were to study the correlation between OSCE scores and scores obtained to traditional knowledge examinations and to analyse factors associated with better OSCE performance in DFASM1 and 2 students at Dijon university hospital. METHODS This was a prospective observational study conducted among all fourth and fifth year medical students in Dijon. The scores on the OSCE elective tests (2022) and the average score on the knowledge tests (2021-2022) were collected and their correlation measured. A questionnaire asked students about their demographic characteristics, their investment in formative and practicum OSCEs, their level of empathy (Jefferson questionnaire) and their personality traits (NEO-Pi-R). RESULTS Of 549 students, 513 completed all tests. Scores on OSCE and faculty knowledge tests were correlated (r=0.39, P<0.001). Of these, 111 (20%) students responded to the questionnaire, and 97 were analized. We did not observe any significant difference between students who performed better on OSCEs than on knowledge tests and those who did not, regarding their age, their investment in formative tests, their personality traits or their level of empathy. CONCLUSION Our results underline the need to optimize the evaluation of empathy and clinical skills in OSCE tests, using new tools, in order to better discriminate between students on these skills.
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Affiliation(s)
- M Nguyen
- Service d'anesthésie et réanimation, centre hospitalo-universitaire de Dijon-Bourgogne, Dijon, France; UFR des sciences de santé, université de Bourgogne, 21000, Dijon, France.
| | - G Beltramo
- UFR des sciences de santé, université de Bourgogne, 21000, Dijon, France; Service de pneumologie et soins intensifs respiratoires, centre-hospitalo universitaire de Dijon-Bourgogne, Dijon, France
| | - S Audia
- UFR des sciences de santé, université de Bourgogne, 21000, Dijon, France; Service de médecine interne et immunologie cinique, centre-hospitalo universitaire de Dijon-Bourgogne, Dijon, France
| | - H Devilliers
- UFR des sciences de santé, université de Bourgogne, 21000, Dijon, France; Service de médecine interne et maladies systémiques, centre-hospitalo universitaire de Dijon-Bourgogne, Dijon, France; Inserm CIC-EC 1432, centre d'investigation clinique, Dijon, France
| | - A Laurent
- Service d'anesthésie et réanimation, centre hospitalo-universitaire de Dijon-Bourgogne, Dijon, France; UFR des sciences de santé, université de Bourgogne, 21000, Dijon, France; EA 7458, laboratoire psy-DREPI, université de Bourgogne Franche-Comté, Dijon, France
| | - M Blot
- UFR des sciences de santé, université de Bourgogne, 21000, Dijon, France; Inserm CIC-EC 1432, centre d'investigation clinique, Dijon, France; Département de maladies infectieuses, centre hospitalo-universitaire de Dijon-Bourgogne, Dijon, France
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29
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Velasco-Durántez V, Mihic-Góngora L, Coca-Membribes S, Galán-Moral R, Fernández-Montes A, Castillo-Trujillo OA, Sorribes E, Quilez A, Puntí-Brun L, Jiménez-Fonseca P, Calderon C. The Relationship between Therapeutic Alliance and Quality of Care in Patients with Advanced Cancer in Spain. Curr Oncol 2023; 30:3580-3589. [PMID: 37185386 PMCID: PMC10137084 DOI: 10.3390/curroncol30040273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
The therapeutic alliance is an important factor in successful cancer treatment, particularly for those with advanced cancer. This study aims to determine how the therapeutic alliance relates to prognostic preferences and satisfaction with the physician and medical care among patients with advanced cancer. We conducted a cross-sectional study to explore the therapeutic relationship, trust, satisfaction with healthcare, and prognostic preferences among 946 patients with advanced cancer at 15 tertiary hospitals in Spain. Participants completed questionnaires with self-reported measures. Most were male, aged > 65 years, with bronchopulmonary (29%) or colorectal (16%) tumors and metastatic disease at diagnosis. Results revealed that 84% of patients had a good therapeutic alliance. Collaborative and affective bond was positively associated with a preference to know the prognosis and satisfaction with care and decision. There was no difference in a therapeutic alliance based on clinical or sociodemographic factors. The therapeutic alliance between patient and physician is essential for successful treatment outcomes and better overall satisfaction. Therefore, it is vital for healthcare providers to focus on establishing and maintaining a strong relationship with their patients. To achieve this, transparency and care should be prioritized, as well as respect for the preferences of patients regarding the prognosis of their illness.
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30
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Santel M, Neuner F, Berg M, Steuwe C, Jobes DA, Driessen M, Beblo T. The Collaborative Assessment and Management of Suicidality compared to enhanced treatment as usual for inpatients who are suicidal: A randomized controlled trial. Front Psychiatry 2023; 14:1038302. [PMID: 36937739 PMCID: PMC10017970 DOI: 10.3389/fpsyt.2023.1038302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Although use of inpatient crisis hospital intervention for suicide risk is common, the evidence for inpatient treatments that reduce suicidal thoughts and behaviors is remarkably limited. To address this need, this novel feasibility pilot randomized controlled trial compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced treatment as usual (E-TAU) within a standard acute inpatient mental health care setting. Objectives We hypothesized that CAMS would be more effective than E-TAU in reducing suicidal thoughts and behaviors. As secondary outcomes we also investigated depressive symptoms, general symptom burden, reasons for living, and quality of the therapeutic relationship. Methods All patients were admitted due to acute suicidal thoughts or behaviors. They were randomly assigned to CAMS (n = 43) or E-TAU (n = 45) and assessed at four time points (admission, discharge, 1 month and 5 months after discharge). We used mixed-effects models, effect sizes, and reliable change analyses to compare improvements across and between treatment groups over time. Results Intent-to-treat analyses of 88 participants [mean age 32.1, SD = 13.5; n = 47 (53%) females] showed that both groups improved over time across all outcome measures with no significant between-group differences in terms of change in suicidal ideation, depression, reasons for living, and distress. However, CAMS showed larger effect sizes across all measures; for treatment completers CAMS patients showed significant improvement in suicidal ideation (p = 0.01) in comparison to control patients. CAMS patients rated the therapeutic relationship significantly better (p = 0.02) than E-TAU patients and were less likely to attempt suicide within 4 weeks after discharge (p = 0.05). Conclusions CAMS and E-TAU were both effective in reducing suicidal thoughts and symptom distress. Within this feasibility RCT the pattern of results was generally supportive of CAMS suggesting that inpatient use of CAMS is both feasible and promising. However, our preliminary results need further replication within well-powered multi-site randomized controlled trials. Trial registration DRKS-ID/ICTRP-ID: DRKS00013727. The trial was retrospectively registered in the German Clinical Trials Register, registration code/ DRKS-ID: DRKS00013727 on 12.01.2018 and also in the International Clinical Trials Registry Platform of the World Health Organization (identical registration code).
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Affiliation(s)
- Miriam Santel
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
- *Correspondence: Miriam Santel
| | - Frank Neuner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Michaela Berg
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Carolin Steuwe
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - David A. Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, United States
| | - Martin Driessen
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Thomas Beblo
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
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Puder D, Dominguez C, Borecky A, Ing A, Ing K, Martinez AE, Pereau M, Kashner TM. Assessing Interpersonal Relationships in Medical Education: the Connection Index. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:683-691. [PMID: 35064549 DOI: 10.1007/s40596-021-01574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The relationship between a resident physician and his/her supervising attending is foundational to graduate medical education and may impact the clinical learning environment and resident well-being. This paper focuses on how to measure connection between a resident and their clinical supervisor. Connection includes the subdomains of psychological safety, empathy, educational alliance, and feedback. METHODS After reviewing the literature, the authors designed the 12-item, 7-point Connection Index (CI12) to quantitatively measure connections between a resident and his/her supervisor during a 6-month period (supervision dyad), and based on educational alliance, empathy, psychological safety, and effective feedback. A 9-criteria evaluation framework was applied to assess its reliability and validity on a sample of psychiatry residents at a residency program, July 2016 through June 2018. RESULTS Out of a total possible number of 50 residents, 100% participated to rate 41 supervisors over 201 supervision dyads; the CI12 satisfied all eight of the eight testable criteria, including high scalability (H = 0.78), consistency (alpha = 0.98), test-retest validity (ICC = 0.95), and construct validity where CI12 was found to have statistically significant correlations with outcomes measures (greater connection was associated with less negative emotional experiences, less mistreatment or bias, less burnout, and higher attendance to supervision sessions). CONCLUSION The authors showed the CI12 can be a valid and reliable instrument to quantify whether a resident and his/her supervisor connects during a 6-month supervision with respect to empathy, psychological safety, educational alliance, and feedback. We recommend assessing connections as part of the overall evaluation of a resident's experience with the clinical learning environment.
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Affiliation(s)
- David Puder
- Loma Linda University School of Medicine, Loma Linda, CA, USA.
| | - Chloe Dominguez
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Adam Borecky
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Alice Ing
- University of California at Irvine, Irvine, CA, USA
| | - Kevin Ing
- University of California at Irvine, Irvine, CA, USA
| | | | - Melissa Pereau
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - T Michael Kashner
- Loma Linda University School of Medicine, Loma Linda, CA, USA
- Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC, USA
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Aoki Y, Yaju Y, Utsumi T, Sanyaolu L, Storm M, Takaesu Y, Watanabe K, Watanabe N, Duncan E, Edwards AG. Shared decision-making interventions for people with mental health conditions. Cochrane Database Syst Rev 2022; 11:CD007297. [PMID: 36367232 PMCID: PMC9650912 DOI: 10.1002/14651858.cd007297.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND One person in every four will suffer from a diagnosable mental health condition during their life. Such conditions can have a devastating impact on the lives of the individual and their family, as well as society. International healthcare policy makers have increasingly advocated and enshrined partnership models of mental health care. Shared decision-making (SDM) is one such partnership approach. Shared decision-making is a form of service user-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision. This review assesses whether SDM interventions improve a range of outcomes. This is the first update of this Cochrane Review, first published in 2010. OBJECTIVES To assess the effects of SDM interventions for people of all ages with mental health conditions, directed at people with mental health conditions, carers, or healthcare professionals, on a range of outcomes including: clinical outcomes, participation/involvement in decision-making process (observations on the process of SDM; user-reported, SDM-specific outcomes of encounters), recovery, satisfaction, knowledge, treatment/medication continuation, health service outcomes, and adverse outcomes. SEARCH METHODS We ran searches in January 2020 in CENTRAL, MEDLINE, Embase, and PsycINFO (2009 to January 2020). We also searched trial registers and the bibliographies of relevant papers, and contacted authors of included studies. We updated the searches in February 2022. When we identified studies as potentially relevant, we labelled these as studies awaiting classification. SELECTION CRITERIA Randomised controlled trials (RCTs), including cluster-randomised controlled trials, of SDM interventions in people with mental health conditions (by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. We used GRADE to assess the certainty of the evidence. MAIN RESULTS This updated review included 13 new studies, for a total of 15 RCTs. Most participants were adults with severe mental illnesses such as schizophrenia, depression, and bipolar disorder, in higher-income countries. None of the studies included children or adolescents. Primary outcomes We are uncertain whether SDM interventions improve clinical outcomes, such as psychiatric symptoms, depression, anxiety, and readmission, compared with control due to very low-certainty evidence. For readmission, we conducted subgroup analysis between studies that used usual care and those that used cognitive training in the control group. There were no subgroup differences. Regarding participation (by the person with the mental health condition) or level of involvement in the decision-making process, we are uncertain if SDM interventions improve observations on the process of SDM compared with no intervention due to very low-certainty evidence. On the other hand, SDM interventions may improve SDM-specific user-reported outcomes from encounters immediately after intervention compared with no intervention (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) 0.26 to 1.01; 3 studies, 534 participants; low-certainty evidence). However, there was insufficient evidence for sustained participation or involvement in the decision-making processes. Secondary outcomes We are uncertain whether SDM interventions improve recovery compared with no intervention due to very low-certainty evidence. We are uncertain if SDM interventions improve users' overall satisfaction. However, one study (241 participants) showed that SDM interventions probably improve some aspects of users' satisfaction with received information compared with no intervention: information given was rated as helpful (risk ratio (RR) 1.33, 95% CI 1.08 to 1.65); participants expressed a strong desire to receive information this way for other treatment decisions (RR 1.35, 95% CI 1.08 to 1.68); and strongly recommended the information be shared with others in this way (RR 1.32, 95% CI 1.11 to 1.58). The evidence was of moderate certainty for these outcomes. However, this same study reported there may be little or no effect on amount or clarity of information, while another small study reported there may be little or no change in carer satisfaction with the SDM intervention. The effects of healthcare professional satisfaction were mixed: SDM interventions may have little or no effect on healthcare professional satisfaction when measured continuously, but probably improve healthcare professional satisfaction when assessed categorically. We are uncertain whether SDM interventions improve knowledge, treatment continuation assessed through clinic visits, medication continuation, carer participation, and the relationship between users and healthcare professionals because of very low-certainty evidence. Regarding length of consultation, SDM interventions probably have little or no effect compared with no intervention (SDM 0.09, 95% CI -0.24 to 0.41; 2 studies, 282 participants; moderate-certainty evidence). On the other hand, we are uncertain whether SDM interventions improve length of hospital stay due to very low-certainty evidence. There were no adverse effects on health outcomes and no other adverse events reported. AUTHORS' CONCLUSIONS This review update suggests that people exposed to SDM interventions may perceive greater levels of involvement immediately after an encounter compared with those in control groups. Moreover, SDM interventions probably have little or no effect on the length of consultations. Overall we found that most evidence was of low or very low certainty, meaning there is a generally low level of certainty about the effects of SDM interventions based on the studies assembled thus far. There is a need for further research in this area.
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Affiliation(s)
- Yumi Aoki
- Department of Psychiatric and Mental Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Yukari Yaju
- Department of Epidemiology and Biostatistics for Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Tomohiro Utsumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Leigh Sanyaolu
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Marianne Storm
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
- Department of Neuropsychiatry, University of the Ryukyus, Okinawa, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
| | - Edward Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, The University of Stirling, Scotland, UK
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Polillo A, Voineskos AN, Foussias G, Kidd SA, Bromley S, Soklaridis S, Wang W, Stergiopoulos V, Kozloff N. Disengagement from early psychosis intervention services: an observational study informed by a survey of patient and family perspectives. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:94. [PMID: 36369306 PMCID: PMC9651118 DOI: 10.1038/s41537-022-00300-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Approximately one-third of patients with early psychosis disengage from services before the end of treatment. We sought to understand patient and family perspectives on early psychosis intervention (EPI) service engagement and use these findings to elucidate factors associated with early disengagement, defined as dropout from EPI in the first 9 months. Patients aged 16-29 referred to a large EPI program between July 2018-February 2020 and their family members were invited to complete a survey exploring facilitators and barriers to service engagement. A prospective chart review was conducted for 225 patients consecutively enrolled in the same EPI program, receiving the NAVIGATE model of coordinated specialty care, between July 2018-May 2019. We conducted a survival analysis, generating Kaplan-Meier curves depicting time to disengagement and Cox proportional hazards models to determine rate of disengagement controlling for demographic, clinical, and program factors. The survey was completed by 167 patients and 79 family members. The top endorsed engagement facilitator was related to the therapeutic relationship in both patients (36.5%) and families (43.0%). The top endorsed barrier to engagement was medication side effects in both patients (28.7%) and families (39.2%). In Cox proportional hazards models, medication nonadherence (HR = 2.37, 95% CI = 1.17-4.80) and use of individual psychotherapy (HR = .460, 95% CI = 0.220-0.962) were associated with early disengagement, but some of the health equity factors expected to affect engagement were not. Findings suggest that delivery of standardized treatment may buffer the effects of health disparities on service disengagement in early psychosis.
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Affiliation(s)
- Alexia Polillo
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - George Foussias
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sarah Bromley
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sophie Soklaridis
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Morvillers JM, Roy C, Laouénan C, Goutté N. [Therapeutic alliance between sectorial psychiatry inpatients and nurses and aides: A prospective, observational and cross-sectional study]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:854-863. [PMID: 35786001 PMCID: PMC9561694 DOI: 10.1177/07067437221111377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Therapeutic alliance represents a rarely studied object when it relates to nurses and care provided by a nursing team in acute care hospitalization. OBJECTIVE The objective was to study how factors might influence the therapeutic alliance built between nurses and aides and adult inpatients in an acute care unit of sectorial general psychiatry. METHOD This is a prospective, observational and cross-sectional study using a therapeutic alliance measurement scale. Therapeutic alliance (TA) score was measured with a STAR-P scale in a sample of 240 patients. RESULTS The median score found is 33.4 (±7.8) out of a maximum theoretical score of 48. The global score of TA in patients aged 60 years old or more is significantly higher than the score of patients between 18 and 29 years old (p=0.021). The lack of external follow-up in the three months after hospital release is not associated with TA global score (p=0.73). If inpatients, no matter what their diseases or types of care are, under legal obligation or not, consider their TA is rather good after their hospital stay. Only sociodemographic factors like age, housing conditions (insecure or sustainable), having a job or not, living alone or with a partner affect TA and follow-up. CONCLUSION Results evoke concepts of anomie and attachment, that seem to play an important role in the lack of follow-up after hospital stay, and indicate the mandatory global approach to care and an involvement of health professionals as well as social beings, where empathy must find its place.
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Affiliation(s)
| | - Carine Roy
- Département d’Epidémiologie, Biostatistiques et Recherche Clinique,
Hôpital Bichat Claude Bernard, Paris
| | - Cédric Laouénan
- Département d’Epidémiologie, Biostatistiques et Recherche Clinique,
Hôpital Bichat Claude Bernard, Paris
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Farhall J, Castle D, Constantine E, Foley F, Kyrios M, Rossell S, Arnold C, Leitan N, Villagonzalo KA, Brophy L, Fossey E, Meyer D, Mihalopoulos C, Murray G, Nunan C, Sterling L, Thomas N. Using a digital personal recovery resource in routine mental health practice: feasibility, acceptability and outcomes. J Ment Health 2022; 32:567-574. [PMID: 36072983 DOI: 10.1080/09638237.2022.2118688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Digital technologies enable the dissemination of multimedia resources to support adults with serious mental illness in their self-management and personal recovery. However, delivery needs to accommodate engagement and accessibility challenges. AIMS We examined how a digital resource, designed for mental health workers and consumers to use together in session, would be used in routine practice. METHODS Thirty consumers and their workers participated. The web-based resource, Self-Management And Recovery Technology (SMART), was available to use within and between sessions, for a 6-month period. Workers initiated in-session use where relevant. Feasibility was explored via uptake and usage data; and acceptability and impact via questionnaires. A pre-post design assessed recovery outcomes for consumers and relationship outcomes for consumers and workers. RESULTS In participating mental health practitioner-consumer dyads, consumers gave strong acceptability ratings, and reported improved working relationships. However, the resource was typically used in one-third or fewer appointments, with consumers expressing a desire for greater in-session use. Improvements in self-rated personal recovery were not observed, possibly contributed to by low usage. CONCLUSIONS In-session use was found helpful by consumers but may be constrained by other demands in mental health care delivery: collaborative use may require dedicated staff time or more formal implementation.
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Affiliation(s)
- John Farhall
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne, Australia
| | - David Castle
- Department of Psychiatry, St Vincent's Hospital and The University of Melbourne, Melbourne, Australia
| | | | - Fiona Foley
- Centre for Mental Health Swinburne University of Technology, Melbourne, Australia
| | - Michael Kyrios
- Órama Institute for Mental Health & Wellbeing Flinders University, Adelaide, Australia
| | - Susan Rossell
- Centre for Mental Health Swinburne University of Technology, Melbourne, Australia.,Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
| | - Chelsea Arnold
- Centre for Mental Health Swinburne University of Technology, Melbourne, Australia
| | - Nuwan Leitan
- Centre for Mental Health Swinburne University of Technology, Melbourne, Australia
| | | | - Lisa Brophy
- School of Allied Health Human Services and Sport, La Trobe University and the Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ellie Fossey
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.,Living with Disability Research Centre La Trobe University, Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health Swinburne University of Technology, Melbourne, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics Institute for Health Transformation Deakin University, Geelong, Australia
| | - Greg Murray
- Centre for Mental Health Swinburne University of Technology, Melbourne, Australia
| | | | - Leon Sterling
- Centre for Design Innovation Swinburne University of Technology, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health Swinburne University of Technology, Melbourne, Australia.,Alfred Health, Melbourne, Australia
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Grover S, Naskar C, Sahoo S, Mehra A. Clinician's experience of telepsychiatry consultations. Asian J Psychiatr 2022; 75:103207. [PMID: 35944405 PMCID: PMC9356673 DOI: 10.1016/j.ajp.2022.103207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Chandrima Naskar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kumar R, Chakrabarti S, Ghosh A. Composition of treatment alliance in bipolar disorder: A cross-sectional study of patients’ perspectives. World J Psychiatry 2022; 12:814-826. [PMID: 35978971 PMCID: PMC9258269 DOI: 10.5498/wjp.v12.i6.814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/08/2021] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment alliance has an impact on several key patient outcomes in all psychiatric disorders, including bipolar disorder (BD). It has been suggested that the construct of treatment alliance is different among patients from routine psychiatric settings compared to psychotherapeutic settings. However, research on the composition of treatment alliance in psychiatric disorders, such as BD, is relatively limited.
AIM To determine whether a broader construct of treatment alliance was prevalent among outpatients with BD.
METHODS This is a cross-sectional study, conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (September 2018 to September 2019). A consecutive sample of 160 remitted adult outpatients with BD on mood stabilizers for at least a year were selected. The principal instrument to assess treatment alliance was the Working Alliance Inventory-client version (WAI-Client). Other potential constituents of the alliance explored were perceived trust in clinicians assessed by the Trust in Physicians (TRIP) scale, perceived support from clinicians assessed by the Psychosocial Care by Physicians (PCP) scale, and perceived treatment satisfaction assessed by the Patient Satisfaction Questionnaire (PSQ). Associations between scores on all scales were determined by correlational and multiple regression analyses. Exploratory factor analysis of combined items of all scales was conducted using a principal components analysis.
RESULTS Scores on all the three WAI-Client subscales were significantly correlated with each other (r = 0.66-0.81; P < 0.0001). The total TRIP scores were associated with the total WAI-Client scores (r = 0.28; P < 0.01). The total TRIP scores and the total PCP scores were also significantly associated with the WAI-Client scores on the Task subscale (r = 0.28-0.29; P < 0.01). The total TRIP scores were significantly associated with the total PSQ scores (r = 0.45; P < 0.0001). Factor analysis yielded two independent and coherent factors, which explained 69% of the variance in data. Factor-1 (“alliance and support”), which explained about 41% of the variance, was comprised of a combined WAI-Client goal-task-bond component as well as the PCP support items. Factor-2 (“trust and satisfaction”), which explained about 28% of the variance, consisted of all the TRIP trust and the PSQ treatment satisfaction items.
CONCLUSION A broader construct of treatment alliance in BD was found. Apart from collaborative components, this construct included patients’ perceptions regarding trust in clinicians, support from clinicians, and treatment satisfaction.
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Affiliation(s)
- Rajeet Kumar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Perlman D, Moxham L, Patterson C, Tapsell A, Keough E. The influence of a self-determination theory grounded clinical placement on nursing student's therapeutic relationship skills: A pre-test/post-test study. Int J Ment Health Nurs 2022; 31:305-312. [PMID: 34820992 DOI: 10.1111/inm.12957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
For undergraduate nursing students, an integral mode of learning is their clinical placements. Learning within the clinical setting is influenced by factors such as the facilitators, peers, unit, or department the student is placed on. What is not known is the role of a social context that is grounded in Self-Determination Theory and how this influences the development of therapeutic relationship skills among undergraduate nursing students. The aim of this study was to examine the role of autonomy support in the professional learning of undergraduate nursing students. This study employed a two-group pre-test and post-test design, with undergraduate nursing students placed in either an autonomy-supportive group or a comparison group in an Australian context. Therapeutic relationship skills were assessed at the beginning and end of their compulsory mental health clinical placement. Participants were 210 (n = 210) Australian undergraduate nursing students. Using a tertile split, 140 students were placed into one of two groups based on their perception of autonomy support at the post-test time point. Pre- and post-test therapeutic relationship data were collected for both groups. A repeated measures analysis of variance was used to examine whether engagement in different clinical placements would illicit significant differences in therapeutic relationship skills. Undergraduate nursing students who were engaged in the autonomy-supportive setting had significantly higher scores associated with the therapeutic relationship subscales: Positive Collaboration and Positive Clinical Input. The importance of the social context is underscored, which is strongly influenced by the educational leader, typically referred to as a nurse facilitator.
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Affiliation(s)
- Dana Perlman
- School of Education: Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lorna Moxham
- School of Education: Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Christopher Patterson
- School of Nursing: Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Amy Tapsell
- Global Challenges Program, Research and Innovation Division, University of Wollongong, Wollongong, New South Wales, Australia
| | - Emily Keough
- School of Psychology: Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
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Murphy R, Kettner H, Zeifman R, Giribaldi B, Kartner L, Martell J, Read T, Murphy-Beiner A, Baker-Jones M, Nutt D, Erritzoe D, Watts R, Carhart-Harris R. Therapeutic Alliance and Rapport Modulate Responses to Psilocybin Assisted Therapy for Depression. Front Pharmacol 2022; 12:788155. [PMID: 35431912 PMCID: PMC9009076 DOI: 10.3389/fphar.2021.788155] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/07/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Across psychotherapeutic frameworks, the strength of the therapeutic alliance has been found to correlate with treatment outcomes; however, its role has never been formally assessed in a trial of psychedelic-assisted therapy. We aimed to investigate the relationships between therapeutic alliance and rapport, the quality of the acute psychedelic experience and treatment outcomes. Methods: This 2-arm double-blind randomized controlled trial compared escitalopram with psychedelic-assisted therapy for moderate-severe depressive disorder (N = 59). This analysis focused on the psilocybin condition (n = 30), who received two oral doses of 25 mg psilocybin, 3-weeks apart, with psychological preparation, in-session support, and integration therapy. A new psychedelic therapy model, called “Accept-Connect-Embody” (ACE), was developed in this trial. The primary outcome was depression severity 6 weeks post treatment (Quick Inventory of Depressive Symptomatology, QIDS-SR-16). Path analyses tested the hypothesis that therapeutic alliance (Scale To Assess the Therapeutic Relationship Patient Version, STAR-P) would predict depression outcomes via its influence on the acute psychedelic experience, specifically emotional-breakthrough (EBI) and mystical-type experiences (MEQ). The same analysis was performed on the escitalopram arm to test specificity. Results: The strength of therapeutic alliance predicted pre-session rapport, greater emotional-breakthrough and mystical-type experience (maximum EBI and MEQ scores across the two psilocybin sessions) and final QIDS scores (β = −0.22, R2 = 0.42 for EBIMax; β = −0.19, R2 = 0.32 for MEQMax). Exploratory path models revealed that final depression outcomes were more strongly affected by emotional breakthrough during the first, and mystical experience during the second session. Emotional breakthrough, but not mystical experience, during the first session had a positive effect on therapeutic alliance ahead of the second session (β = 0.79, p < 0.0001). Therapeutic alliance ahead of the second session had a direct impact on final depression scores, not mediated by the acute experience, with a weaker alliance ahead of the second psilocybin session predicting higher absolute depression scores at endpoint (β = −0.49, p < 0.001) Discussion: Future research could consider therapist training and characteristics; specific participant factors, e.g., attachment style or interpersonal trauma, which may underlie the quality of the therapeutic relationship, the psychedelic experience and clinical outcomes; and consider how therapeutic approaches might adapt in cases of weaker therapeutic alliance. Clinical Trial Registration: This trial is registered at http://clinicaltrials.gov, identifier (NCT03429075).
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Affiliation(s)
- Roberta Murphy
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Medical Psychotherapy, South West London and St. Georges NHS Trust, London, United Kingdom
- *Correspondence: Roberta Murphy,
| | - Hannes Kettner
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Rick Zeifman
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Bruna Giribaldi
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Laura Kartner
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Jonny Martell
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Medical Psychotherapy and General Adult Psychiatry, Devon Partnership NHS Trust, Exeter, United Kingdom
| | - Tim Read
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Ashleigh Murphy-Beiner
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Department of Psychology, Royal Holloway University, Surrey, United Kingdom
| | - Michelle Baker-Jones
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - David Nutt
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - David Erritzoe
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Rosalind Watts
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Robin Carhart-Harris
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Psychedelics Division Neuroscape, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
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Zarzycka B, Jankowski T, Szostek D, Di Malta G, Cooper M. Relational depth from the perspective of the psychotherapy dyad: Psychometric properties of the Relational Depth Frequency Scale. Psychother Res 2022; 32:910-921. [DOI: 10.1080/10503307.2022.2038803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Beata Zarzycka
- Institute of Psychology, John Paul II Catholic University of Lublin, Lublin, Poland
| | - Tomasz Jankowski
- Institute of Psychology, John Paul II Catholic University of Lublin, Lublin, Poland
| | - Dorota Szostek
- Institute of Psychology, John Paul II Catholic University of Lublin, Lublin, Poland
| | - Gina Di Malta
- Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
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Bar‐El J, Gil TE. Attachment and the therapeutic bond in a community mental health clinic: A pilot study. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Juan Bar‐El
- Acre Community Mental Health Clinic Mazor Mental Health Center Acre Israel
| | - Tsvi E. Gil
- Acre Community Mental Health Clinic Mazor Mental Health Center Acre Israel
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Torres C, Rosenblum KL, Jester JM, Julian MM, Niec LN, Muzik M. Clinician Racial Biases: Preliminary Investigation on Predictors of Poor Therapeutic Alliance and Retention in Home Visiting Intervention Program. Matern Child Health J 2022; 26:953-961. [PMID: 35107688 PMCID: PMC9018578 DOI: 10.1007/s10995-021-03369-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Home visiting programs are effective in improving maternal-child health, and higher therapeutic alliance is associated with improved program retention and outcomes. Black, single, low-income mothers have a higher risk for poorer health outcomes in pregnancy and postpartum and for early termination of therapeutic services. OBJECTIVE To examine associations between clinician and client alliance and social, economic, and racial demographics. METHODS Mothers (N = 71) who were pregnant or had an infant (age < 24 m) receiving Infant Mental Health (IMH) services through community health service agencies and their clinicians (N = 50) completed the Scale to Assess Therapeutic Relationships (clinicians: STAR-C, clients: STAR-P) at 3-, 6-, 9-, and 12 months, and provided demographic information. RESULTS Survival analysis showed those with higher alliance ratings, both client and clinician ratings, at the 3-month time-point were more likely to remain in treatment longer (for clients est = -1.67, p = .0017; for clinician est = -.75, p = .031). Controlling for clinician experience and frequency of reflective supervision, Black clinicians had higher alliance ratings than white clinicians, (b = 3.1 (1.6), p = .049). Neither clinician-client racial match nor client marital status predicted alliance. Black clinicians' ratings of alliance did not vary by client race, but white clinicians reported weaker alliance with their Black, relative to white, clients (β = .40, p = .045). CONCLUSIONS Weaker alliance reported by white clinicians with Black clients, coupled with a lack of client-race related differences for Black clinicians, suggests white clinician racial bias may be important to consider in regards to program retention and health disparities.
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Affiliation(s)
- Chioma Torres
- Department of Pediatrics, University of Michigan Medical School, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA.
| | - Katherine L Rosenblum
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA.,Department of Obstetrics & Gynecology, University of Michigan Medical School, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA
| | - Jennifer M Jester
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Megan M Julian
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Larissa N Niec
- Center for Children, Families, and Communities, Central Michigan University, 2480 West Campus Drive, Suite B100, Mount Pleasant, MI, 48858, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA.,Department of Obstetrics & Gynecology, University of Michigan Medical School, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA
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Grover S, Naskar C, Mehra A, Sahoo S. Clinician's experience of telepsychiatry consultations with elderly patients. JOURNAL OF GERIATRIC MENTAL HEALTH 2022. [DOI: 10.4103/jgmh.jgmh_31_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Coelho JCF, Sampaio FMC, Nogueira MJC, Sequeira CADC, Lleixà Fortuño MDM, Roldán Merino J. Development and psychometric properties of the Therapeutic Relationship Assessment Scale-Nurse. J Psychiatr Ment Health Nurs 2021; 28:981-994. [PMID: 34494341 DOI: 10.1111/jpm.12796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The literature shows a clear relationship between a good therapeutic relationship (TR) and the efficacy of nursing interventions. For the implementation of nursing psychotherapeutic interventions, the initial establishment of a good TR is essential. Several instruments assess the relationship established between the therapist and the patient in psychotherapy. However, no tool has been found to assess the quality of the TR established between the nurse and the patient. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study allowed the development and evaluation of the psychometric properties of a scale to assess the TR between the nurse and the patient in a sample of mental health nurses. The developed scale (Therapeutic Relationship Assessment Scale-Nurse) has psychometric properties that attest its reliability (internal consistency and test-retest) and construct validity as an instrument to assess the quality of the TR established between the nurse and the patient from the nurse's perspective. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: As the TR is crucial for providing nursing care and, in particular, for implementing nursing psychotherapeutic interventions, the scale developed is a valid tool to assess the quality of the TR established between the nurse and the patient in the perspective of the mental health nurse. The use of instruments to assess the quality of the nurse-patient TR facilitates the identification of the relationship's gaps, which can serve as a basis for improving the relationship itself and the nursing care provision. ABSTRACT: Introduction The therapeutic relationship (TR) is essential to providing psychiatric and mental health nursing care. Nevertheless, no assessment tools exclusive for assessing nursing TR were found in the literature. Aim To describe and evaluate the psychometric properties (reliability and construct validity) of a scale that allows assessing the quality of TR established between the nurse and the patient. Method A survey method was adopted, using a convenience sample of 356 mental health nurses. Internal consistency was assessed by Cronbach's alpha and Omega index. Results A total of 221 mental health nurses participated in the study (response rate = 62.08%). The scale's final structure has 25 items. Cronbach's alpha was 0.93, ranging from 0.78 to 0.88 for each of the factors. The cumulative variance explained in a four-factor structure was 71.12%. Discussion The Therapeutic Relationship Assessment Scale (TRAS)-Nurse presents good psychometric properties. In the light of Benner's theory, it can be an useful tool for novice nurses to better understand what aspects they should pay attention to for establishing a successful TR. Implications for Practice Mental health nurses can use the TRAS-Nurse, thus having a scale available that allows them to self-assess the quality of TR they establish with their patients.
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Affiliation(s)
- Joana Catarina Ferreira Coelho
- University Rovira i Virgili, Tarragona, Spain.,Psychiatry Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal.,Nursing School of Porto, Porto, Portugal.,NursID Research Group, CINTESIS, Porto, Portugal
| | | | - Maria José Carvalho Nogueira
- NursID Research Group, CINTESIS, Porto, Portugal.,Escola Superior de Enfermagem Cruz Vermelha Portuguesa - Alto Tâmega, Chaves, Portugal
| | | | | | - Juan Roldán Merino
- Nursing School of Barcelona, Campus Docent Sant Joan de Déu-Private Foundation, University of Barcelona, Barcelona, Spain.,GEIMAC Research Group (Group Consolidat 2017-1681: Group of Studies of Invariance of the Instruments of Measurement and Analysis of the Change in the Social and Health Areas), Barcelona, Spain
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van Haaren M, de Jong S, Roeg DPK. The foundations of the working alliance in assertive community treatment teams. BMC Psychiatry 2021; 21:559. [PMID: 34758777 PMCID: PMC8582115 DOI: 10.1186/s12888-021-03563-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In this study, we aimed to identify and define the fundamental components of the working alliance in multidisciplinary (Flexible) Assertive Community Treatment teams with shared caseloads, in order to support their daily practice and further research. METHODS After reviewing the literature, concept mapping with professionals and clients was used to define the working alliance in (F) ACT teams. The resulting concept maps formed the basis for the working alliance assessment instrument, which was pilot tested with professionals and clients through cognitive interviews with a think-aloud procedure. RESULTS The study led to the development of a twenty five-item assessment instrument to evaluate working alliances in multidisciplinary teams (WAM) that was comprised of three subscales: bond, task/goal and team. Two different versions were developed for clients and professionals. CONCLUSIONS The WAM instrument was developed to determine the quality of the working alliance in (F) ACT teams. Future research will focus on testing its psychometric properties and predictive value.
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Affiliation(s)
- M. van Haaren
- grid.491104.9Department of Outpatient Psychiatry/Department of Forensic Psychiatry, GGzE Direct/De Woenselse Poort, GGzE, Eindhoven, the Netherlands
| | - S. de Jong
- grid.468630.f0000 0004 0631 9338Research Department, Lentis Groningen, the Netherlands
| | - D. P. K. Roeg
- grid.12295.3d0000 0001 0943 3265Tilburg University, Tilburg, the Netherlands/Tranzo & Kwintes Supported Housing, PO Box 90153, 5000 LE Tilburg, Zeist, the Netherlands
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Popescu C, Golden G, Benrimoh D, Tanguay-Sela M, Slowey D, Lundrigan E, Williams J, Desormeau B, Kardani D, Perez T, Rollins C, Israel S, Perlman K, Armstrong C, Baxter J, Whitmore K, Fradette MJ, Felcarek-Hope K, Soufi G, Fratila R, Mehltretter J, Looper K, Steiner W, Rej S, Karp JF, Heller K, Parikh SV, McGuire-Snieckus R, Ferrari M, Margolese H, Turecki G. Evaluating the Clinical Feasibility of an Artificial Intelligence-Powered, Web-Based Clinical Decision Support System for the Treatment of Depression in Adults: Longitudinal Feasibility Study. JMIR Form Res 2021; 5:e31862. [PMID: 34694234 PMCID: PMC8576598 DOI: 10.2196/31862] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Approximately two-thirds of patients with major depressive disorder do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence-powered clinical decision support systems (CDSSs) to assist physicians in their treatment selection and management, improving the personalization and use of best practices such as measurement-based care. Previous literature shows that for digital mental health tools to be successful, the tool must be easy for patients and physicians to use and feasible within existing clinical workflows. OBJECTIVE This study aims to examine the feasibility of an artificial intelligence-powered CDSS, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural network-based individualized treatment remission prediction. METHODS Owing to the COVID-19 pandemic, the study was adapted to be completed entirely remotely. A total of 7 physicians recruited outpatients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Patients completed a minimum of one visit without the CDSS (baseline) and 2 subsequent visits where the CDSS was used by the physician (visits 1 and 2). The primary outcome of interest was change in appointment length after the introduction of the CDSS as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semistructured interviews. RESULTS Data were collected between January and November 2020. A total of 17 patients were enrolled in the study; of the 17 patients, 14 (82%) completed the study. There was no significant difference in appointment length between visits (introduction of the tool did not increase appointment length; F2,24=0.805; mean squared error 58.08; P=.46). In total, 92% (12/13) of patients and 71% (5/7) of physicians felt that the tool was easy to use; 62% (8/13) of patients and 71% (5/7) of physicians rated that they trusted the CDSS. Of the 13 patients, 6 (46%) felt that the patient-clinician relationship significantly or somewhat improved, whereas 7 (54%) felt that it did not change. CONCLUSIONS Our findings confirm that the integration of the tool does not significantly increase appointment length and suggest that the CDSS is easy to use and may have positive effects on the patient-physician relationship for some patients. The CDSS is feasible and ready for effectiveness studies. TRIAL REGISTRATION ClinicalTrials.gov NCT04061642; http://clinicaltrials.gov/ct2/show/NCT04061642.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Kelly Perlman
- Aifred Health Inc., Montreal, QC, Canada
- McGill University, Montreal, QC, Canada
| | | | | | | | | | | | | | | | | | | | | | - Soham Rej
- McGill University, Montreal, QC, Canada
| | | | | | | | | | - Manuela Ferrari
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | | | - Gustavo Turecki
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
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Spriggs MJ, Douglass HM, Park RJ, Read T, Danby JL, de Magalhães FJC, Alderton KL, Williams TM, Blemings A, Lafrance A, Nicholls DE, Erritzoe D, Nutt DJ, Carhart-Harris RL. Study Protocol for "Psilocybin as a Treatment for Anorexia Nervosa: A Pilot Study". Front Psychiatry 2021; 12:735523. [PMID: 34744825 PMCID: PMC8563607 DOI: 10.3389/fpsyt.2021.735523] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/15/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Anorexia nervosa (AN) is a serious and life-threatening psychiatric condition. With a paucity of approved treatments, there is a desperate need for novel treatment avenues to be explored. Here, we present (1) an overview of the ways through which Public Patient Involvement (PPI) has informed a trial of psilocybin-assisted therapy for AN and (2) a protocol for a pilot study of psilocybin-assisted therapy in AN currently underway at Imperial College London. The study aims to assess the feasibility, brain mechanisms and preliminary outcomes of treating anorexia nervosa with psilocybin. Methods: (1) PPI: Across two online focus groups, eleven individuals with lived experience of AN were presented with an overview of the protocol. Their feedback not only identified solutions to possible barriers for future participants, but also helped the research team to better understand the concept of "recovery" from the perspective of those with lived experience. (2) Protocol: Twenty female participants [21-65 years old, body mass index (BMI) 15 kg/m2 or above] will receive three oral doses of psilocybin (up to 25 mg) over a 6-week period delivered in a therapeutic environment and enveloped by psychological preparation and integration. We will work with participant support networks (care teams and an identified support person) throughout and there will be an extended remote follow-up period of 12 months. Our two-fold primary outcomes are (1) psychopathology (Eating Disorder Examination) across the 6-month follow-up and (2) readiness and motivation to engage in recovery (Readiness and Motivation Questionnaire) across the 6-week trial period. Neurophysiological outcome measures will be: (1) functional magnetic resonance imaging (fMRI) brain changes from baseline to 6-week endpoint and (2) post-acute changes in electroencephalography (EEG) activity, including an electrophysiological marker of neuronal plasticity. Discussion: The results of this pilot study will not only shed light on the acceptability, brain mechanisms, and impression of the potential efficacy of psilocybin as an adjunct treatment for AN but will be essential in shaping a subsequent Randomised Control Trial (RCT) that would test this treatment against a suitable control condition. Clinical Trial Registration: identifier: NCT04505189.
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Affiliation(s)
- Meg J. Spriggs
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Hannah M. Douglass
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Rebecca J. Park
- OxBREaD Research Group, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Tim Read
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Jennifer L. Danby
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Kirsty L. Alderton
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Tim M. Williams
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Allan Blemings
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Adele Lafrance
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
| | - Dasha E. Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - David Erritzoe
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - David J. Nutt
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Robin L. Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
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Increasing access to cognitive–behavioural therapy for patients with psychosis by evaluating the feasibility of a randomised controlled trial of brief, targeted cognitive–behavioural therapy for distressing voices delivered by assistant psychologists: the GiVE2 trial. BJPsych Open 2021. [PMCID: PMC8388007 DOI: 10.1192/bjo.2021.983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background
Cognitive–behavioural therapy (CBT) is recommended for all patients with psychosis, but is offered to only a minority. This is attributable, in part, to the resource-intensive nature of CBT for psychosis. Responses have included the development of CBT for psychosis in brief and targeted formats, and its delivery by briefly trained therapists. This study explored a combination of these responses by investigating a brief, CBT-informed intervention targeted at distressing voices (the GiVE intervention) administered by a briefly trained workforce of assistant psychologists.
Aims
To explore the feasibility of conducting a randomised controlled trial to evaluate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists to patients with psychosis.
Method
This was a three-arm, feasibility, randomised controlled trial comparing the GiVE intervention, a supportive counselling intervention and treatment as usual, recruiting across two sites, with 1:1:1 allocation and blind post-treatment and follow-up assessments.
Results
Feasibility outcomes were favourable with regard to the recruitment and retention of participants and the adherence of assistant psychologists to therapy and supervision protocols. For the candidate primary outcomes, estimated effects were in favour of GiVE compared with supportive counselling and treatment as usual at post-treatment. At follow-up, estimated effects were in favour of supportive counselling compared with GiVE and treatment as usual, and GiVE compared with treatment as usual.
Conclusions
A definitive trial of the GiVE intervention, delivered by assistant psychologists, is feasible. Adaptations to the GiVE intervention and the design of any future trials may be necessary.
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van Lotringen CM, Jeken L, Westerhof GJ, ten Klooster PM, Kelders SM, Noordzij ML. Responsible Relations: A Systematic Scoping Review of the Therapeutic Alliance in Text-Based Digital Psychotherapy. Front Digit Health 2021; 3:689750. [PMID: 34713164 PMCID: PMC8521857 DOI: 10.3389/fdgth.2021.689750] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Developing a good therapeutic alliance is considered essential for the responsible delivery of psychotherapy. Text-based digital psychotherapy has become increasingly common, yet much remains unclear about the alliance and its importance for delivering mental health care via a digital format. To employ text-based digital therapies responsibly, more insight is needed into the type and strength of the therapeutic alliance online. Methods: A systematic scoping review was performed searching four databases: Scopus, PsycINFO, Web of Science, and Wiley Online Library. A total of 23 studies were selected and data was extracted and tabulated to explore the characteristics of studies on text-based psychotherapy, measurements of the therapeutic alliance and associations of the alliance with treatment outcome. Results: The therapeutic alliance in text-based digital interventions was studied with a variety of client groups, though mostly for clients diagnosed with anxiety and/or depression issues. Treatment modalities were predominantly internet-based cognitive behavioral therapy (ICBT) and tailored platforms for distinct client groups (e.g., PTSD). Almost all treatments used asynchronous text-based communication, such as e-mails and integrated messaging functions, which were mainly used to give feedback on tasks. For measurements, a version of the Working Alliance Inventory (WAI) was used in most studies. Measurements with the WAI or WAI- short form indicated a good therapeutic alliance with a weighted mean score of 5.66 (on a scale of 1 to 7) and a weighted standard deviation of 0.84. Relations between the therapeutic alliance and treatment outcomes were mostly positive, with many studies reporting significant associations (n = 8 out of 10) or significant effects of the therapeutic alliance on treatment outcomes (n = 5 out of 6). Discussion: Our scoping review suggests that a good therapeutic alliance can be established in digital psychotherapy through text-based communication, and shows support for a positive relationship between the alliance and treatment outcomes. These findings illustrate that text-based online psychotherapy can be a responsible treatment option as far as the establishment of the therapeutic alliance is concerned. However, current measures of the therapeutic alliance might miss important aspects of the alliance in digital treatment, such as the presence of empathy or compassion.
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Zarzycka B, Jankowski T, Krasiczyńska B. Therapeutic relationship and professional burnout in psychotherapists: A structural equation model approach. Clin Psychol Psychother 2021; 29:250-259. [PMID: 34125500 DOI: 10.1002/cpp.2629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/04/2021] [Accepted: 06/08/2021] [Indexed: 11/08/2022]
Abstract
Previous studies on the therapists' burnout have focused on individual and environmental risk factors. This study aimed to analyse whether variables reflecting therapeutic relationship-the therapist experience of relational depth and quality of the therapeutic relationship-can be related to psychotherapist burnout. Four alternative path models were examined. A total of 101 humanistic-experiential psychotherapists, aged between 29 and 86 years, participated in the research. The Relational Depth Frequency Scale, the Scale to Assess the Therapeutic Relationship, the Psychological Well-Being Scale and the Link Burnout Questionnaire were applied to the research. The results showed that relational depth and therapeutic quality correlated negatively with psychotherapist burnout. Relational depth is the main predictor of psychological well-being and psychotherapist burnout through its effect on therapeutic quality. The experiences of relational depth, primarily of person-centred therapists, have positive psychological potential in predicting lower professional burnout.
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Affiliation(s)
- Beata Zarzycka
- Institute of Psychology, The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Tomasz Jankowski
- Institute of Psychology, The John Paul II Catholic University of Lublin, Lublin, Poland
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