Meta‐Analysis of Therapist Effects in Psychotherapy Outcome Studies

Crits‐Christoph, Paul; Baranackie, Kathryn; Kurcias, Julie S.; Beck, Aaron T.; Carroll, Kathleen M.; Perry, Kevin; Luborsky, Lester; McLellan, A. Thomas; Woody, George; Thompson, Larry W.; Gallagher, Dolores; Zitrin, Charlotte Marker

doi:10.1080/10503309112331335511

Cited by 414 publications

(300 citation statements)

References 14 publications

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“…Thus, simply actively or passively engaging patients in treatments designed to control for the amount of clinician contact did not appear to confer any benefit in cognitive functioning beyond the provision of usual services. These findings are consistent with the meta-analysis of the cognitive remediation-based integrated psychological therapy program (39) but differ from the psychotherapy literature, where there is ample evidence for nonspecific effects related to therapist attention (40). The mechanisms underlying the effects of cognitive remediation on improved cognitive performance, functioning, and symptoms appear to differ from those involved in psychotherapy.…”

Section: Discussionsupporting

confidence: 79%

A Meta-Analysis of Cognitive Remediation in Schizophrenia

McGurk¹,

Twamley²,

Sitzer³

et al. 2007

AJP

1,067

830

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Objective-This study evaluated the effects of cognitive remediation for improving cognitive performance, symptoms, and psychosocial functioning in schizophrenia.Method-A meta-analysis was conducted of 26 randomized, controlled trials of cognitive remediation in schizophrenia including 1,151 patients.Results-Cognitive remediation was associated with significant improvements across all three outcomes, with a medium effect size for cognitive performance (0.41), a slightly lower effect size for psychosocial functioning (0.36), and a small effect size for symptoms (0.28). The effects of cognitive remediation on psychosocial functioning were significantly stronger in studies that provided adjunctive psychiatric rehabilitation than in those that provided cognitive remediation alone.Conclusions-Cognitive remediation produces moderate improvements in cognitive performance and, when combined with psychiatric rehabilitation, also improves functional outcomes.Cognitive impairment is a core feature of schizophrenia, with converging evidence showing that it is strongly related to functioning in areas such as work, social relationships, and independent living (1, 2). Furthermore, cognitive functioning is a robust predictor of response to psychiatric rehabilitation (i.e., systematic efforts to improve the psychosocial functioning of persons with severe mental illness) (3), including outcomes such as work, social skills, and self-care (1,4,5). Because of the importance of cognitive impairment in schizophrenia, it has been identified as an appropriate target for interventions (6).Currently available pharmacological treatments have limited effects on cognition in schizophrenia (7,8) and even less impact on community functioning (9). To address the problem of cognitive impairment in schizophrenia, a range of cognitive remediation programs has been developed and evaluated over the past 40 years. These programs employ a variety of methods, such as drill and practice exercises, teaching strategies to improve cognitive functioning, compensatory strategies to reduce the effects of persistent cognitive impairments, and group discussions. Several reviews of research on cognitive rehabilitation in schizophrenia have been published (10-13). The general conclusions from these reviews have been that cognitive remediation NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript leads to modest improvements in performance on neuropsychological tests but has no impact on functional outcomes. However, these reviews were limited by the relatively small number of studies that actually measured psychosocial functioning, precluding any definitive conclusions about the effects of cognitive remediation on psychosocial adjustment or the identification of program characteristics that may contribute to such effects. The rationale for cognitive remediation is chiefly predicated on its presumed effects on psychosocial functioning and improved response to rehabilitation. Therefore, a critical examination of the effects of cognitive ...

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Section: Discussionsupporting

confidence: 79%

A Meta-Analysis of Cognitive Remediation in Schizophrenia

McGurk¹,

Twamley²,

Sitzer³

et al. 2007

AJP

1,067

830

View full text Add to dashboard Cite

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“…Usually, around 5% variance in psychotherapy are due to therapist effects (Baldwin & Imel, 2013), and greater therapist effects are expected when the therapists are inexperienced (Crits-Christoph et al, 1991). In the current study, trainees were therapists, and that may have caused a small decrease in outcome.…”

Section: Limitationsmentioning

confidence: 99%

The relationship between clients’ personality traits, working alliance and therapy outcome in a training context

Dennhag¹,

Ybrandt²,

Sundström³

2017

Current Issues in Personality Psychology

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Background Clients’ differences in personality include both psychopathology and normal personality variations and constitute an important factor for the therapeutic process and outcome. There is a lack of empirical data on the impact of clients’ personalities on therapeutic relationships and outcomes, particularly in a training context. Participants and procedure This longitudinal study investigated the relationships between client personality traits, changes in those traits after cognitive behavioral or psychodynamic short-term therapy, and clients’ perceived working alliances with their therapists and their clinical outcomes at a university training clinic in Sweden. Participants were 138 clients with moderate psychological symptoms. Personality traits were measured using the Health-Relevant Personality Inventory. Results The results showed that Antagonism, Impulsivity, Hedonic Capacity, and Negative Affectivity improved significantly during therapy, while Alexithymia did not. Pre-therapy personality traits were not related to perceived working alliances (Working Alliance Inventory) or therapeutic outcomes (Clinical Outcomes in Routine Evaluation Outcome Measure). Post-therapy personality traits negative affectivity, hedonic capacity and alexithymia were related to working alliance, and changes in personality traits were predictive of therapy outcome. The change in Hedonic Capacity and Negative Affectivity explained about 20% of the variance in post-therapy symptoms after controlling for pre-therapy symptoms. Conclusions The results suggest that therapeutic foci on hedonism (extraversion) and negative affectivity (neuroticism) could be important for working alliance formation and symptom reduction in therapy. Future research should examine whether changes in clients’ negative affectivity or hedonic capacity mediate the relation between perceived working alliance quality and clinical outcome in training and other psychotherapeutic contexts.

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“…As mentioned before, reduced variance regarding alliance has been noted in CBT in comparison to psychodynamic therapy (Raue et al, 1997). But it should also be noted that we used experienced therapists, who could be expected to show smaller between-therapist differences than less experienced therapists (Crits-Christoph et al, 1991).…”

Section: The Therapeutic Relationshipmentioning

confidence: 99%

Behavioral Treatments of Panic Disorder with Agoraphobia: Treatment Process and Determinants of Change

Ramnerö¹

2005

PsycEXTRA Dataset

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The present dissertation comprises four empirical studies within the area of behavioral treatment of panic disorder with agoraphobia. The focus is on studying issues pertaining to outcome, treatment process and determinants of change. The first study is a randomized controlled treatment study of 73 patients undergoing 16 sessions of either exposure in vivo (E), or cognitive behavior therapy (CBT). Both treatments showed clear improvements at post-treatment that were well maintained at 1-year follow up, and there were no significant differences between the treatments. The second study concerned prediction of outcome in the same sample. From a variety of pre-treatment characteristics severity of avoidance was the one most related to outcome. Most predictors were found unrelated. Two approaches of prediction were also compared: treating outcome as a categorical vs. continuous variable. The different approaches yielded a somewhat dissimilar picture of the impact of pre-treatment severity of avoidance. The third study examined different aspects of the therapeutic relationship, and their relation to outcome. Clients' perceptions of therapists and their ratings of the working alliance were generally not related to outcome at any point. On the other hand, therapists' perceptions of patients as showing goal-direction and active participation were related to outcome from early on in therapy. The fourth study examined different aspects of change. It was found that change in indices of the frequency of panic attacks was not closely related to change in agoraphobic avoidance at post-treatment. Change in avoidance was also more related to other aspects of outcome. At one-year follow-up, a more unitary picture, regarding the different aspects of change was observed.

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Meta‐Analysis of Therapist Effects in Psychotherapy Outcome Studies

Cited by 414 publications

References 14 publications

A Meta-Analysis of Cognitive Remediation in Schizophrenia

A Meta-Analysis of Cognitive Remediation in Schizophrenia

The relationship between clients’ personality traits, working alliance and therapy outcome in a training context

Behavioral Treatments of Panic Disorder with Agoraphobia: Treatment Process and Determinants of Change

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