Early symptom change in adult outpatients: Relationship with patient characteristics and therapeutic alliance

2015 ◽  
Vol 89 (4) ◽  
pp. 402-417 ◽  
Author(s):  
Dave Smits ◽  
Nele Stinckens ◽  
Koen Luyckx ◽  
Laurence Claes
Keyword(s):  
Therapeutic Alliance ◽  
Patient Characteristics ◽  
Symptom Change ◽  
Early Symptom

Comparing the Ratio of Therapist Support to Internet Sessions in a Blended Therapy Delivered to Trauma-Exposed Veterans (Preprint)

2021 ◽  
Author(s):  
Marylene Cloitre ◽  
Miryam Wassef ◽  
Julianna B. Hogan ◽  
Terri L. Fletcher ◽  
Christie Jackson ◽  
...  
Keyword(s):  
Therapeutic Alliance ◽  
Clinical Care ◽  
Patient Characteristics ◽  
Experimental Comparison ◽  
Completion Rates ◽  
Treatment Conditions ◽  
Quasi Experimental ◽  
Symptom Outcome ◽  
Therapist Support

BACKGROUND Blended models which incorporate elements of both internet and face-to-face therapies have been shown to be effective. Therapist and patients have expressed concerns that less rather more therapy sessions relative to self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates and poorer outcomes. OBJECTIVE A multi-site quasi-experimental comparison study with a noninferiority design conducted in routine clinical care was used to assess webSTAIR, a 10-module blended therapy for trauma-exposed individuals delivered with 10 weekly therapist sessions (Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be “as good as” Coach10 regarding a range of outcomes. METHODS : A total of 202 Veterans were enrolled in the study (Coach5 n = 101, Coach10 n = 101). PTSD symptoms, depression, emotion regulation, interpersonal problems and social functioning measures were collected at pretreatment, mid, posttreatment and 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons of continuous and categorical measures regarding participant and therapist activities were conducted. RESULTS : Participants reported moderate to severe levels of baseline PTSD and/or depression. Significant reductions were obtained on all symptom measures at post and 3-month follow-up. Coach5 was not inferior to Coach10 on any outcome. Therapeutic alliance was high and equivalent across the two treatment conditions and completion rates and web usage were similar. Coach5 therapists’ total session time was substantially less than Coach10. Both programs were associated with a low and equal number of therapist activities related to scheduling and crisis/motivational sessions. CONCLUSIONS A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions among individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes in high versus low dose of therapist support will help create flexible technology-based intervention programming.

scholarly journals The Temporal Associations of Therapeutic Alliance and Manual Adherence With Depressive Symptom Change in Cognitive Behavioral Therapy for Adult Outpatient Major Depression

2021 ◽  
Vol 11 ◽  
Author(s):  
Frank J. Don ◽  
Ellen Driessen ◽  
Jaap Peen ◽  
Jan Spijker ◽  
Robert J. DeRubeis ◽  
...  
Keyword(s):  
Depressive Symptom ◽  
Cognitive Behavioral Therapy ◽  
Therapeutic Alliance ◽  
Linear Mixed Model ◽  
Rating Scale ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Symptom Change ◽  
Depression Change ◽  
Perceived Helpfulness

Background: The therapeutic alliance is considered an important causal agent of psychotherapy efficacy. However, studies in cognitive behavioral therapy (CBT) for depression have suggested that alliance might be more of a consequence rather than a cause of depressive symptom change, while adherence to CBT specific techniques was found to be associated with subsequent depression change. We aimed to add to this body of literature by assessing the temporal associations of both therapeutic alliance and manual adherence with depressive symptom change in a relatively large sample of depressed adult outpatients over the full course of CBT.Methods: Adults with a major depressive episode (n = 98) participating in a randomized clinical trial were offered 22 weeks of CBT and rated the Penn Helping Alliance Questionnaire (HAq-I) at weeks 5 and 22. Therapists rated their adherence to the CBT manual after each session and observers assessed the Hamilton Depression Rating Scale scores at weeks 0, 5, 10, and 22. Linear mixed model analyses were used to assess the associations of alliance and adherence with prior and subsequent depression change.Results: HAq-I Relationship and manual adherence ratings were not significantly associated with prior nor with subsequent depression change (p > 0.14). Prior depression change was associated with the HAq-I subscale Perceived helpfulness at the end of treatment (r = 0.30, CI = 0.03–0.56, p = 0.03).Conclusion: We were not able to replicate prior depression change in CBT for depression to be associated with improved quality of the therapeutic alliance when using a more “pure” measure of the therapeutic relationship. Limitations of this study include the subjective alliance and adherence assessments. Our findings indicate the need to appropriately distinguish between the perceived helpfulness and the relationship factors when examining therapeutic alliance.

Diagnostic Challenges for the Mental Health Team and Psychiatrist

2017 ◽  
Author(s):  
Lorna Myers ◽  
John J. Barry
Keyword(s):  
Therapeutic Alliance ◽  
Patient Characteristics ◽  
Inpatient Setting ◽  
Developmentally Delayed ◽  
Psychiatric Interview ◽  
Mental Health Team ◽  
Psychogenic Nonepileptic Seizures ◽  
Nonepileptic Seizures ◽  
High Event

Establishing a positive therapeutic alliance during the initial psychiatric interview allows the clinician to collect the necessary diagnostic information and can have a significant impact on a patient’s decision to follow up with treatment recommendations once the diagnosis of psychogenic nonepileptic seizures (PNES) is determined. When evaluating a patient with suspected PNES in an out- or inpatient setting, there are a variety of clinician behaviors that can support or obstruct the establishment of a positive therapeutic alliance. Similarly, a number of typical patient characteristics in PNES can affect the psychiatric assessment. In this chapter, these characteristics and behaviors are discussed, a clinician checklist is provided, and dialogue boxes illustrate a few common patient–clinician interactions, hypothetical challenges, and clinician responses. Distinctive challenges, including interaction with specific PNES subtypes (i.e., developmentally delayed, malingering, or hostile patients) and patients who are effectively incapacitated by high event frequency and systemic barriers, are presented.

scholarly journals Homework Completion, Patient Characteristics, and Symptom Change in Cognitive Processing Therapy for PTSD

2018 ◽  
Vol 49 (5) ◽  
pp. 741-755 ◽  
Author(s):  
Shannon Wiltsey Stirman ◽  
Cassidy A. Gutner ◽  
Michael K. Suvak ◽  
Abby Adler ◽  
Amber Calloway ◽  
...  
Keyword(s):  
Cognitive Processing ◽  
Patient Characteristics ◽  
Cognitive Processing Therapy ◽  
Symptom Change ◽  
Homework Completion

Early symptom change and prediction of subsequent remission with olanzapine augmentation in divalproex-resistant bipolar mixed episodes

2011 ◽  
Vol 45 (2) ◽  
pp. 169-173 ◽  
Author(s):  
John P. Houston ◽  
Terence A. Ketter ◽  
Michael Case ◽  
Charles Bowden ◽  
Elisabeth K. Degenhardt ◽  
...  
Keyword(s):  
Symptom Change ◽  
Early Symptom

scholarly journals The therapeutic alliance in a naturalistic psychiatric setting: Temporal relations with depressive symptom change

2014 ◽  
Vol 61 ◽  
pp. 70-77 ◽  
Author(s):  
Christian A. Webb ◽  
Courtney Beard ◽  
Randy P. Auerbach ◽  
Eliza Menninger ◽  
Thröstur Björgvinsson
Keyword(s):  
Depressive Symptom ◽  
Therapeutic Alliance ◽  
Temporal Relations ◽  
Symptom Change ◽  
Psychiatric Setting

scholarly journals Predictors of patient cognitive therapy skills and symptom change in two randomized clinical trials: The role of therapist adherence and the therapeutic alliance.

2012 ◽  
Vol 80 (3) ◽  
pp. 373-381 ◽  
Author(s):  
Christian A. Webb ◽  
Robert J. DeRubeis ◽  
Sona Dimidjian ◽  
Steven D. Hollon ◽  
Jay D. Amsterdam ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Therapeutic Alliance ◽  
Cognitive Therapy ◽  
Randomized Clinical Trials ◽  
Symptom Change ◽  
Therapist Adherence
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