Limited Motivation, Patient-Therapist Mismatch, and the Therapeutic Alliance

Nadai, Alessandro S. De; Karver, Marc S.

doi:10.1007/978-1-4614-6458-7_17

Cited by 3 publications

(2 citation statements)

References 133 publications

(150 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Increasing Precision of Personalized Intervention via Use of Machine Learning. Traditional approaches to treatment matching remain somewhat limited in their success (De Nadai & Karver, 2013). While prior approaches to treatment matching have generally used strongly justified hypotheses, many other factors on which patients can be matched to treatment may have not been identified through traditional research.…”

Section: Personalized Interventionsmentioning

confidence: 99%

Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination

Nadai

Etherton

2021

J Cogn Psychother

Self Cite

View full text Add to dashboard Cite

Nearly all patients interact with critical gatekeepers—insurance companies or centralized healthcare systems. For mental health dissemination efforts to be successful, these gatekeepers must refer patients to evidence-based care. To make these referral decisions, they require evidence about the amount of resources expended to achieve therapeutic gains. Without this information, a bottleneck to widespread dissemination of evidence-based care will remain. To address this need for information, we introduce a new perspective, clinical efficiency. This approach directly ties resource usage to clinical outcomes. We highlight how cost-effectiveness approaches and other strategies can address clinical efficiency, and we also introduce a related new metric, the incremental time efficiency ratio (ITER). The ITER is particularly useful for quantifying the benefits of low-intensity and concentrated interventions, as well as stepped-care approaches. Given that stakeholders are increasingly requiring information on resource utilization, the ITER is a metric that can be estimated for past and future clinical trials. As a result, the ITER can allow researchers to better communicate desirable aspects of treatment, and an increased focus on clinical efficiency can improve our ability to deliver high-quality treatment to more patients in need.

show abstract

Section: Personalized Interventionsmentioning

confidence: 99%

Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination

Nadai

Etherton

2021

J Cogn Psychother

Self Cite

View full text Add to dashboard Cite

show abstract

“…Specifically, interpersonal resistance in CBT for anxiety has been a reliable negative predictor of outcome that can be changed with specific therapist responses (Aviram, Westra, Constantino, & Antony, 2016; Poulin, Button, Westra, Constantino, & Antony, 2018). This illustrates the clinical utility of such interaction‐level assessments: they help identify areas where different responses from therapists could contribute to improved motivation and better outcomes (De Nadai & Karver, 2013).…”

Section: Introductionmentioning

confidence: 98%

The predictive value of patient, therapist, and in‐session ratings of motivational factors early in remote cognitive behavioural therapy for severe health anxiety

Malins

Moghaddam

Morriss

et al. 2021

British J Clinic Psychol

View full text Add to dashboard Cite

Objectives. Remote psychotherapy and the prevalence of Severe Health Anxiety (SHA) are both growing as a result of the COVID-19 pandemic. Remotely delivered Cognitive Behavioural Therapy (rCBT) for SHA is evidenced as effective, but many who seek help do not benefit. Motivational processes can influence outcomes, but it is unclear what assessment methods offer the best clinical utility in rCBT for SHA.Design. This study compared the predictive validity of patient, therapist and in-session ratings of motivational factors taken at session two of rCBT for SHA among high healthcare users experiencing multimorbidity.Methods. Motivational factors were assessed for 56 participants who attended at least two sessions of CBT for SHA delivered via video-conferencing or telephone. Following session two, therapists and patients completed online assessments of patient motivation. Two trained observers also rated motivational factors and therapeutic alliance from insession interactions using session two recordings and transcripts. Multilevel modelling was used to predict health anxiety and a range of secondary health outcomes from motivation assessments.Results. Where patients were more actively engaged in discussion of positive changes during session two, greater outcome improvements ensued in health anxiety and all secondary outcomes. Conversely, larger proportions of session two spent describing problems predicted poorer outcomes. Therapist and patient assessments of motivation did not predict health anxiety, but therapist assessments of client confidence and motivation predicted all secondary outcomes.Conclusions. Motivation remains an important process in CBT when delivered remotely, and motivational factors may predict outcomes more consistently from insession interactions, compared to self-reports.The COVID-19 pandemic has led to a dramatic increase in the provision of psychotherapy via video-conferencing (Wind, Rijkeboer, Andersson, & Riper, 2020). An increase in demand for psychotherapy is also expected for Severe Health Anxiety (SHA; Asmundson

show abstract

Addressing Patient Motivation, Therapeutic Alliance, and Treatment Expectancies in Interventions for Anxiety Disorders

Nadai

King

Karver

et al. 2014

The Wiley Handbook of Anxiety Disorders

View full text Add to dashboard Cite

Limited Motivation, Patient-Therapist Mismatch, and the Therapeutic Alliance

Cited by 3 publications

References 133 publications

Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination

Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination

The predictive value of patient, therapist, and in‐session ratings of motivational factors early in remote cognitive behavioural therapy for severe health anxiety

Addressing Patient Motivation, Therapeutic Alliance, and Treatment Expectancies in Interventions for Anxiety Disorders

Contact Info

Product

Resources

About