Association of Patient Treatment Preference With Dropout and Clinical Outcomes in Adult Psychosocial Mental Health Interventions

Windle, Emma; Tee, Helena; Sabitova, Alina; Jovanović, Nikolina; Priebe, Stefan; Carr, Catherine

doi:10.1001/jamapsychiatry.2019.3750

Cited by 122 publications

(83 citation statements)

References 73 publications

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“…The increase of therapeutic strategies for depression is of particular importance as it allows better personalization to be provided according to patients’ preferences. In fact, studies have shown that receiving a preferred treatment is associated with stronger therapeutic alliance, lower dropout rates, and positive treatment outcomes (Lindhiem, Bennett, Trentacosta, & McLear, 2014 ; Swift, Callahan, Cooper, & Parkin, 2018 ; Windle et al, 2020 ). It is also essential to routinely evaluate the presence of adverse childhood experiences and traumatic events in people with depression in order to identify if trauma-focused psychotherapies such as EMDR could be more effective for patients with a history of maltreatment.…”

Section: Discussionmentioning

confidence: 99%

Eye movement desensitization and reprocessing for depression: a systematic review and meta-analysis

Carletto

Malandrone

Berchialla

et al. 2021

European Journal of Psychotraumatology

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Background : In recent years, eye movement desensitization and reprocessing (EMDR) has been applied to different psychiatric conditions beyond post-traumatic stress disorder (PTSD), and an increasing number of studies have evaluated its effect on depression. To date, no quantitative synthesis of the efficacy of EMDR on depression has been conducted. Objective : To meta-analytically review the studies on EMDR for depression as the primary target for treatment. Method : Studies with a controlled design evaluating the effect of EMDR on depression were searched on six electronic databases (PubMed, Embase, CINAHL, PsycINFO, Cochrane database, and Francine Shapiro Library) and then selected by two independent reviewers. A systematic review and meta-analysis was conducted. Results : Eleven studies were included for qualitative synthesis. Nine studies were included in the meta-analysis, involving 373 participants. The overall effect size of EMDR for depressive symptoms is large ( n = 9, Hedges’ g = – 1.07; 95%CI [–1.66; – 0.48]), with high heterogeneity ( I 2 = 84%), and corresponds to a ‘number needed to treat’ of 1.8. At follow-up (range 3–6 months), the effect remains significant but moderate ( n = 3, Hedges’ g = – 0.62; 95%CI [–0.97; – 0.28]; I 2 = 0%). The effect of EMDR compared with active controls is also moderate ( n = 7, g = – 0.68; 95%CI [–0.92; – 0.43]; I 2 = 0%). No publication bias was found, although the results are limited by the small number and poor methodological quality of the included studies. Conclusions : Review findings suggest that EMDR may be considered an effective treatment for improving symptoms of depression, with effects comparable to other active treatments. However, findings need to be interpreted in light of the limited number of the studies and their quality. Further research is required to understand the longer-term of effects EMDR in treating depression and preventing depression relapse. Protocol registration : PROSPERO (CRD42018090086).

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Section: Discussionmentioning

confidence: 99%

Eye movement desensitization and reprocessing for depression: a systematic review and meta-analysis

Carletto

Malandrone

Berchialla

et al. 2021

European Journal of Psychotraumatology

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“…Common sense would suggest that if an individual has a preference for a psychological treatment, they may be more likely to complete it and benefit from it, relative to a treatment they do not prefer. A recent meta-analytic review (Windle et al, 2020) of 29 randomized and non-randomized studies involving 5,294 patients provided evidence to suggest that receiving a preferred psychosocial treatment was associated with lower likelihood of dropping out of treatment (risk ratio (RR)=0.62, 95% confidence interval (CI)=0.48 -0.80). However, receiving one's preferred treatment was not associated with improvement in depression or anxiety (d =0.01,.…”

Section: Preference For Treatmentmentioning

confidence: 99%

Personalized Medicine and Cognitive Behavioral Therapies for Depression: Small Effects, Big Problems, and Bigger Data

et al. 2020

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Cognitive-behavioral therapies (CBTs) are the most widely studied form of psychotherapy for disorders like depression and anxiety. Nonetheless, there is heterogeneity in response to CBTs vs. other treatments. Researchers have become increasingly interested in using pre-treatment individual differences (i.e., moderators) to match patients to the most effective treatments for them. Several methods to combine multiple variables to create precision treatment rules (PTRs) that identify subgroups have been proposed. We review the rationale behind multivariable PTRs as well as the findings of studies that have used different PTRs. We identify conceptual and methodological issues in the literature. Multivariable treatment assignment is a promising avenue of research. Nonetheless, effect sizes appear to be small and most of the samples that have been used to study these questions have been grossly underpowered to detect small effects. We recommend researchers explore multivariable treatment selection strategies, particularly those resembling risk-stratification, in heterogeneous samples of patients undergoing low-intensity CBTs vs. realistic minimal controls.

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“…Although there is evidence that SDM improves patient knowledge about treatment options and increases their sense of involvement in their health care, the effects of SDM on health outcomes at the symptom/syndrome level remain unclear [1]. Across studies where patients with psychiatric disorders are offered a choice between 2 or more treatments, meta-analyses have found that a majority express a preference for psychotherapy over pharmacotherapy, with those receiving their preferred treatment being less likely to drop out, reporting higher treatment satisfaction, and experiencing marginally better clinical outcomes [2-4]. Of note, the majority of studies included in these meta-analyses compared pharmacotherapy to psychotherapy for depression, and the conclusions that could be drawn were significantly limited by heterogeneity across the included studies [5].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Patient’s Choice of Cognitive Behavioural or Psychodynamic Therapy on Outcomes for Panic Disorder: A Doubly Randomised Controlled Preference Trial

Svensson

Nilsson

Perrin

et al. 2020

Psychother Psychosom

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Introduction: It remains unclear whether offering psychiatric patients their preferred treatment influences outcomes at the symptom level. Objective: To assess whether offering patients with panic disorder with/without agoraphobia (PD/A) a choice between 2 psychotherapies yields superior outcomes to random assignment. Methods: In a doubly randomised, controlled preference trial (DRCPT), 221 adults with PD/A were randomly assigned to: choosing panic-focused psychodynamic therapy (PFPP) or panic control treatment (PCT; a form of cognitive behavioural therapy); random assignment to PFPP or PCT; or waiting list control. Primary outcomes were PD/A severity, work status and work absences at post-treatment assessment. Outcomes at post-treatment assessment, 6-, 12-, and 24-month follow-ups were assessed using segmented multilevel linear growth models. Results: At post-treatment assessment, the choice and random conditions were superior to the control for panic severity but not work status/absences. The choice and random conditions did not differ during treatment or follow-up for the primary outcomes. For panic severity, PCT was superior to PFPP during treatment (standardised mean difference, SMD, –0.64; 95% confidence interval, CI, –1.02 to –0.25); PFPP was superior to PCT during follow-up (SMD 0.62; 95% CI 0.27–0.98). There was no allocation by treatment type interaction (SMD –0.57; 95% CI –1.31 to 0.17). Conclusions: Previous studies have found that offering patients their preferred treatment yields small to moderate effects but have not employed designs that could rigorously test preference effects. In this first DRCPT of 2 evidence-based psychotherapies, allowing patients with PD/A to choose their preferred treatment was not associated with improved outcomes. Further DRCPTs are needed.

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Association of Patient Treatment Preference With Dropout and Clinical Outcomes in Adult Psychosocial Mental Health Interventions

Cited by 122 publications

References 73 publications

Eye movement desensitization and reprocessing for depression: a systematic review and meta-analysis

Eye movement desensitization and reprocessing for depression: a systematic review and meta-analysis

Personalized Medicine and Cognitive Behavioral Therapies for Depression: Small Effects, Big Problems, and Bigger Data

The Effect of Patient’s Choice of Cognitive Behavioural or Psychodynamic Therapy on Outcomes for Panic Disorder: A Doubly Randomised Controlled Preference Trial

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