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Expert Perspectives on the Effectiveness of Psychotherapy.

ABSTRACT: The effectiveness of psychotherapeutic care, as well as the implementation of adequate improvements, are in question. A qualitative interview study was carried out in a cyclical research design with a comparative analysis on the basis of thematic coding using Grounded Theory Methodology. An overview of the design, sampling procedure, and data analysis is given. A variety of critical perspectives emerged concerning the state of psychotherapeutic care in Austria. Two perspectives are presented in this paper as interim results: a health care administration perspective states a general lack of knowledge and a possible unmet need, problematizes the underutilized benefit of psychotherapists and describes a shift in regard to the issue of effectiveness of care to the topic of access to psychotherapeutic care and to a problem with the care and work ethics of professionals. In this perspective, one solution may be to implement intermediary organizations, clearinghouses with multi-professional teams, comprehensive documentation and an indication-oriented approach. The health insurance perspective also claims the organization-specific action problem and the lack of rules for clearing in such intermediary organizations, as well as the relevance of regulated, limited access to psychotherapy.

SUBMITTER: Loffler-Stastka H

PROVIDER: S-EPMC10530554 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Expert Perspectives on the Effectiveness of Psychotherapy.

Löffler-Stastka Henriette H Ronge-Toloraya Andreas A Hassemer Simeon S Krajic Karl K

International journal of environmental research and public health 20230911 18

The effectiveness of psychotherapeutic care, as well as the implementation of adequate improvements, are in question. A qualitative interview study was carried out in a cyclical research design with a comparative analysis on the basis of thematic coding using Grounded Theory Methodology. An overview of the design, sampling procedure, and data analysis is given. A variety of critical perspectives emerged concerning the state of psychotherapeutic care in Austria. Two perspectives are presented in ...[more]

PMID: 37754598

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Project description:BackgroundE-mental health applications have been increasingly used in the psychotherapeutic care of patients for several years. State-of-the-art sensor technology could be used to determine digital biomarkers for the diagnosis of mental disorders. Furthermore, by integrating sensors into treatment, relevant contextual information (e.g. field of gaze, stress levels) could be made transparent and improve the treatment of people with mental disorders. An overview of studies on this approach would be useful to provide information about the current status quo.MethodsA systematic review of the use of sensor technology in psychotherapy for children and adolescents was conducted with the aim of investigating the use and effectiveness of sensory technology in psychotherapy treatment. Five databases were searched for studies ranging from 2000 to 2023. The study was registered by PROSPERO (CRD42023374219), conducted according to Cochrane recommendations and used the PRISMA reporting guideline.ResultsOf the 38.560 hits in the search, only 10 publications met the inclusion criteria, including 3 RCTs and 7 pilot studies with a total of 257 subjects. The study population consisted of children and adolescents aged 6 to 19 years with mental disorders such as OCD, anxiety disorders, PTSD, anorexia nervosa and autistic behavior. The psychotherapy methods investigated were mostly cognitive behavioral therapy (face-to-face contact) with the treatment method of exposure for various disorders. In most cases, ECG, EDA, eye-tracking and movement sensors were used to measure vital parameters. The heterogeneous studies illustrate a variety of potential useful applications of sensor technology in psychotherapy for adolescents. In some studies, the sensors are implemented in a feasible approach to treatment.ConclusionSensors might enrich psychotherapy in different application contexts.However, so far there is still a lack of further randomized controlled clinical studies that provide reliable findings on the effectiveness of sensory therapy in psychotherapy for children and adolescents. This could stimulate the embedding of such technologies into psychotherapeutic process.https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023374219, identifier [CRD42023374219].

Project description:Based on patient-reported outcomes data analyzed at the provider level, there is evidence that psychotherapists can possess effectiveness strengths and weaknesses when treating patients with different presenting concerns. These within-therapist differences hold promise for personalizing care by prospectively matching patients to therapists' historical effectiveness strengths. In a double-masked randomized controlled trial (RCT; NCT02990000), such matching outperformed pragmatically determined usual case assignment-which leaves personalized, measurement-based matching to chance-in naturalistic outpatient psychotherapy (Constantino et al., JAMA Psychiatry 78:960-969, 2021). Demonstrating that personalization can be even more precise, some research has demonstrated that the strength of this positive match effect was moderated by certain patient characteristics. Notably, though, it could also be that matching is especially important for some therapists to achieve more effective outcomes. Examining this novel question, the present study drew on the Constantino et al. (JAMA Psychiatry 78:960-969, 2021) trial data to explore three therapist-level moderators of matching: (a) effectiveness "spread" (i.e., greater performance variability across patients' presenting problem domains), (b) overestimation of their measurement-based and problem-specific effectiveness, and (c) the frequency with which they use patient-reported routine outcomes monitoring in their practice. Patients were 206 adults, randomized to the match or control condition, treated by 40 therapists who were crossed over conditions. The therapist variables were assessed at the trial's baseline and patients' symptomatic/functional impairment and global distress were assessed regularly up to 16 weeks of treatment. Hierarchical linear models revealed that only therapist effectiveness spread significantly moderated the match effect for the global distress outcome; for therapists with more spread, the match effect was more pronounced, whereas the match effect was minimal for therapists with less effectiveness spread. Notably, two therapist-level covariates unexpectedly emerged as significant moderators for the symptomatic/functional impairment outcome; for clinicians who consistently treated patients with higher versus lower average severity levels and who relatedly treated a higher proportion of patients with primary presenting problems of substance misuse or violence, the beneficial match effect was even stronger. Thus, measurement-based matching may be especially potent for therapists with more variable effectiveness across problem domains, and who consistently treat patients with more severe presenting concerns or with particular primary problems, which provides further precision in conceptualizing personalized care.

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Expert Perspectives on the Effectiveness of Psychotherapy.

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Expert Perspectives on the Effectiveness of Psychotherapy.

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