Maximizing Psychotherapy Outcome beyond Evidence-Based Medicine

Abstract

Despite evidence that psychotherapy has a positive impact on psychological disorders, 30% of patients fail to respond during clinical trials, and as many as 65% of patients in routine care leave treatment without a measured benefit. In addition, therapists appear to overestimate positive outcomes in their patients relative to measured outcomes and are particularly poor at identifying patients at risk for a negative outcome. These problems suggest the need for measuring and monitoring patient treatment response over the course of treatment while applying standardized methods of identifying at-risk cases. Computer-assisted methods for measuring, monitoring, identifying potential deteriorators, and providing feedback to clinicians are described along with a model that explains why feedback is likely to be beneficial to patients. The results of 12 clinical trials are summarized and suggest that deterioration rates can be substantially reduced in at-risk cases (from baseline rates of 21% down to 13%) and that recovery rates are substantially increased in this subgroup of cases (from a baseline of 20% up to 35%) when therapists are provided this information. When problem-solving methods are added to feedback, deterioration in at-risk cases is further reduced to 6% while recovery/improvement rates rise to about 50%. It is suggested that the feedback methods become a standard of practice. Such a change in patterns of care can be achieved through minimal modification to routine practice but may require discussions with patients about their clinical progress.

IMPULS: Impulsivity-Focused Group Intervention to Reduce Binge Eating Episodes in Patients with Binge Eating Disorder – A Randomised Controlled Trial

“…Such a longer enduring treatment might raise abstinence rates to rates from usual group CBT of about 50% [23]. However, the abstinence rate of 34%, the clinically relevant change of 61% and the low deterioration rate of 15% at the follow-up in the IMPULS group are indeed considerable (compare Lambert [47]). Moreover, the reduction of the BE frequency in the IMPULS trial was initially comparable and even somewhat higher at the follow-up in comparison with Boutelle et al’s [30] pilot trial lasting 4 months with impulsivity-related interventions.…”

“…the frequency of BE episodes in the past 4 weeks, as well as the abstinence rate [45], the frequency of patients with clinically relevant change (min. 50% reduction of BE episodes in the past 4 weeks) and the deterioration rate (50% increase in BE episodes in the past 4 weeks [46, 47]), the frequency of BE days in the past 4 weeks, and the BE days and episodes in the 2 months before, i.e. in months 2 and 3.…”

Mindfulness-Based Cognitive Therapy as a Treatment for Chronic Tinnitus: A Randomized Controlled Trial

“…Future studies should explore associations with patient characteristics and response to MBCT, particularly in the longer term. Future research could also consider the use of systematic patient feedback throughout treatment, particularly using specific measures that can assess deterioration or non-response, a method that can also lead to improved recovery rates [34]. …”

Cognitive-Behavioral Analysis System of Psychotherapy, Drug, or Their Combination for Persistent Depressive Disorder: Personalizing the Treatment Choice Using Individual Participant Data Network Metaregression

“…As deterioration on treatment is an often neglected yet clinically important outcome [30, 31], we set as a secondary outcome:…”