How and when feedback works in psychotherapy: Is it the signal?

Amble, Ingunn; Gude, Tore; Ulvenes, Pål; Stubdal, Sven; Wampold, Bruce E.

doi:10.1080/10503307.2015.1053552

Cited by 16 publications

(12 citation statements)

References 43 publications

(62 reference statements)

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“…We expected a stronger effect for FIT, mainly in the first episode. This would be in line with previous findings about trajectories of change, with most change occurring earlier rather than later in the treatment process indicating, the importance of the critical initial phase (see Miller et al [ 58 ] and also Amble et al [ 59 ] for an overview). Our finding suggests we should reconsider the Time factor.…”

Section: Discussionsupporting

confidence: 91%

The effect of patients’ feedback on treatment outcome in a child and adolescent psychiatric sample: a randomized controlled trial

Jong

Snoek

Klip

2018

Eur Child Adolesc Psychiatry

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The systematic use of feedback from patients on treatment progress and treatment satisfaction is a promising method to increase treatment effectiveness. The extent to which this also applies to the treatment of children with severe psychiatric problems is not clear. We conducted a Randomized Controlled Trial (RCT) to study the effect of adding Feedback Informed Treatment (FIT) to care as usual in a child psychiatric sample. Quality of Life (QoL) was used as the primary outcome measure and symptom severity as the second. Fifty-one therapists from eight Autism Care Teams in a multi-center facility for Child and Adolescent Psychiatry (Karakter) participated and were cluster randomized to the FIT condition ( n = 4 teams) or the Care as Usual (CAU) condition ( n = 4 teams). Children aged 6–18 years, mainly with an Autism Spectrum Disorder (ASD) and treated in one of the Autism Care Teams were allocated to the FIT condition ( n = 86) or the CAU condition ( n = 80). Results indicated that adding FIT leads to an increased QoL [ F (2,165) = 3.16, p = 0.045]. No additional effects were observed for symptom severity decrease [ F (2,158) = 0.19, p = 0.825]. No interaction with time was found for QoL nor symptom severity. Adding FIT in a child psychiatric setting may increase QoL, but does not appear to decrease symptom severity as compared with CAU. It is suggested that FIT positively changes parents’ expectations. Results should be replicated in other child psychiatric samples and with an extended theoretical model.

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Section: Discussionsupporting

confidence: 91%

The effect of patients’ feedback on treatment outcome in a child and adolescent psychiatric sample: a randomized controlled trial

Jong

Snoek

Klip

2018

Eur Child Adolesc Psychiatry

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“…Of the few studies that have attempted to isolate the effect of these multiple working parts, the findings are mixed. For example, whereas some studies suggest that the off-track alert signal may account for ROM's effect (Probst et al, 2013), others have failed to replicate this finding and have instead pointed to the feedback itself (e.g., the graph of patient progress) and the discussion of progress (or lack thereof) with the patient as the most facilitative aspects of ROM (Amble, Gude, Ulvenes, Stubdal, & Wampold, 2016). As should be clear, future research is needed to more precisely understand how ROM systems work, and to establish how best to achieve such positive effects in the most efficient manner.…”

Section: Using Rom To Improve Patient-level Care: Empirical Supportmentioning

confidence: 99%

Ethical implications of routine outcomes monitoring for patients, psychotherapists, and mental health care systems.

Muir¹,

Coyne²,

Morrison³

et al. 2019

Psychotherapy

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Although psychotherapy is generally efficacious, a substantial number of patients fail to improve meaningfully, whereas still others deteriorate. Moreover, psychotherapists have difficulty forecasting which patients are at risk for nonresponse or deterioration, especially when relying predominantly on their judgment. These limitations have implications for the ethical practice of psychotherapy, and they call for remediation strategies. One such strategy involves the use of routine outcomes monitoring (ROM), or the regular collection of core patient progress information that can be fed back to the clinician and patient in real time. ROM-informed analytics outperform clinical judgment in predicting patients who are on or off track for treatment success, which can help psychotherapists plan and responsively adjust their interventions. Additionally, research demonstrates that ROM-generated feedback improves treatment outcomes for the average case who receives versus does not receive it. ROM data can also uncover between-therapist differences in general efficacy, as well as scientifically highlight clinicians' own relative strengths and weaknesses in treating different mental health problems. In light of such evidence, we submit that the research on ROM has matured to the point that it should occupy a central role in discussions of, and guidelines about, the ethical practice of psychotherapy. In this vein, we discuss ROM at patient, psychotherapist, and mental health care systems levels; namely, for each of these stakeholders, we review the extant empirical support before turning to possible ethical implications. Finally, we offer concluding thoughts on the expanding relevance of ROM for helping psychologists fulfill their ethical practice obligations. Clinical Impact StatementQuestion: After surveying relevant research, we discuss the growing role of routine outcomes monitoring (ROM) for helping psychotherapists and mental health care systems fulfill their ethical practice obligations, including maximizing patient benefit and minimizing harm. Findings: There is expanding evidence that ROM-generated information has the potential to improve treatment outcomes at the patient level (e.g., by identifying patients at risk of nonresponse or harm and informing clinician responsiveness to this signal), psychotherapist level (e.g., by helping to establish clinicians' objective strengths and weaknesses that could inform their selective practice and personalized training foci), and mental health care systems level (e.g., by referring patients to empirically good-fitting clinicians within a care network). Meaning: Research on ROM suggests that it should be considered in any discussion about the ethical practice of evidence-based psychotherapy. Next Steps: It will be important for clinical and research efforts to concentrate on increasing ROM implementation to fulfill ethical demands at the patient, psychotherapist, and systems levels.

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“…Inconsistency can be caused by plausible heterogeneity on how therapists actually use ROM systems, by differences on the type of measures included in the system, or by the algorithms and formats of feedback it provides, the type of therapy, among many other factors. Research is needed that unveils how feedback is used and the mechanisms by which feedback influences outcomes (Amble et al., ; Janse et al., ; Moltu et al., ). Greenhalgh, Long, and Flynn () hypothesized that the lack of consistent impact of outcome feedback into practice may be due to the nomothetic nature of the assessment tools used, which provide too general information, whereas therapeutic processes are individualized.…”

mentioning

confidence: 99%

“…More recently, contradictory results were found. A number of studies (e.g., Amble, Gude, Ulvenes, Stubdal, & Wampold, ; Janse et al., ; Kendrick et al., ; Probst, Lambert, Dahlbender, Loew, & Tritt, ) showed that ongoing feedback about outcome progress and therapeutic alliance does not result in a better treatment outcome in CBT, except in the treatment of depression (Janse et al., ). On the other hand, outcomes were enhanced by providing treatment progress and alliance information to both clients and therapists in couple therapy (Anker et al., ; Reese, Toland, Slone, & Norsworthy, ) and in family therapy (Bickman et al., ; Cooper, Stewart, Sparks, & Bunting, ).…”

mentioning

confidence: 99%

How Routine Patient‐Centered Monitoring Relates to Therapeutic Gains in Family Therapy: A Single‐Case Study

Sales

Ferreira²,

Matos

2018

J Marital Family Therapy

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As routine outcome monitoring systems develop, questions emerge about how therapists incorporate feedback into their practice, and how this relates to therapeutic gains. A case of covert grief was monitored in each session with the Personal Questionnaire and the Helpful Aspects of Therapy instruments. At 4 months follow‐up, the Change Interview was administered. Individualized items facilitated access to the private views and needs of each member, which was useful for case formulation and ongoing personalization of the intervention. Qualitative feedback of treatment experiences helped therapists confirm the impacts of interventions, monitor therapeutic alliance, reformulate clinical hypothesis, and plan sessions. Therapists followed a critical triangulation process to decide the clinical meaning of feedback, according to his/her intervention model, expertise, and case‐specific context.

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How and when feedback works in psychotherapy: Is it the signal?

Abstract: The use of OQ®-Analyst should be recommended in psychotherapeutic settings in Norway. Given the inconsistent results regarding the effect of warning signals, definitive conclusions about their effect may depend upon how and for whom it is used.

Cited by 16 publications

References 43 publications

The effect of patients’ feedback on treatment outcome in a child and adolescent psychiatric sample: a randomized controlled trial

The effect of patients’ feedback on treatment outcome in a child and adolescent psychiatric sample: a randomized controlled trial

Ethical implications of routine outcomes monitoring for patients, psychotherapists, and mental health care systems.

How Routine Patient‐Centered Monitoring Relates to Therapeutic Gains in Family Therapy: A Single‐Case Study

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